Evaluation of remifentanil as single drug for awake fiberoptic intubation.
BACKGROUND
Awake fiberoptic intubation is the standard of care for difficult airway management. Quality and success of this technique depend on the experience of the intubating physician and the proper preparation of the patient. The aim of this study was to compare remifentanil (R) as single agent to the combination of fentanyl (F) and midazolam (M), which have been the drugs for analgesia and sedation for this procedure.


METHODS
Seventy-four adult patients requiring nasotracheal intubation were randomly assigned to one of two groups. In group I, (n=37) R was administered in incremental dosages (0.1-0.25-0.5 microg/kg/min) by an infusion pump according to comfort, level of sedation and respiratory depression. In group II, (n=37) analgesia and sedation was achieved by F 1.5 microg/kg and doses of between 1 and 10 mg M, titrated to the individual needs. Patient reactions like grimacing, movement and coughing during intubation were assessed, as well as patient recall of the procedure. Haemodynamic and respiratory parameters were continuously recorded.


RESULTS
Group I patients better tolerated nasal tube passage (P<0.001) and laryngeal tube advancement (P<0.001) than group II. Remifentanil better suppressed hemodynamic response to nasal intubation (P<0.001). No significant difference in respiratory data was recorded. In group I more recall of the procedure was observed (six vs. zero patients, P<0.05).


CONCLUSIONS
Remifentanil in high doses, as the single agent for patient preparation for awake fiberoptic intubation seems to improve intubating conditions, quality and reliability of the procedure. However, a higher incidence of recall is to be expected.
Puchner
W
W
Department of Anesthesia and Intensive Care Medicine, General Hospital of Linz, Austria. wolfgang.puchner@akh.linz.at
Egger
P
P
Pühringer
F
F
Löckinger
A
A
Obwegeser
J
J
Gombotz
H
H
D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D005336:Fiber Optic Technology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D008875:Middle Aged; D009296:Nasal Cavity / Q000502:physiology; D010100:Oxygen / Q000097:blood; D010880:Piperidines / Q000008:administration & dosage; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077208:Remifentanil
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl