title: Remifentanil vs. fentanyl during interventional rigid bronchoscopy under general anaesthesia and spontaneous assisted ventilation.
abstract: The treatment of tracheo-bronchial diseases with rigid bronchoscopy requires general anaesthesia without tracheal intubation. Spontaneous assisted ventilation is a safe modality of ventilation. In this study the use of remifentanil and fentanyl is compared during rigid bronchoscopy with spontaneous assisted ventilation. Ninety high-risk patients received fentanyl or remifentanil with propofol for general anaesthesia. During the maintenance fentanyl was delivered at 6.1 +/- 4.6 micrograms kg-1 h-1 and remifentanil at 0.15 +/- 0.07 microgram kg-1 min-1. The same degree of intra-operative respiratory acidosis with similar good operating conditions resulted in both groups. Patients treated with remifentanil recovered more quickly compared with those in the fentanyl group (3.8 +/- 2 vs. 10.4 +/- 9.2 min, P < 0.001). In conclusion, the use of remifentanil during rigid bronchoscopy under general anaesthesia with spontaneous assisted ventilation is safe and assures good operating conditions. Moreover, remifentanil permits a more rapid recovery than fentanyl. The dose of remifentanil is higher than previously described for spontaneously breathing patients.
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Natalini
authors.forename: P
authors.initials: P
authors.lastname: Fassini
authors.forename: V
authors.initials: V
authors.lastname: Seramondi
authors.forename: G
authors.initials: G
authors.lastname: Amicucci
authors.forename: C
authors.initials: C
authors.lastname: Toninelli
authors.forename: S
authors.initials: S
authors.lastname: Cavaliere
authors.forename: A
authors.initials: A
authors.lastname: Candiani
mesh_terms: D000768:Anesthesia, General; D018686:Anesthetics, Intravenous; D001784:Blood Gas Analysis; D020680:Bronchoscopes; D001999:Bronchoscopy; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D012121:Respiration, Artificial
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol