title: Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil.
abstract: Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. For that reason, we compared two different dosage regimens. Twenty-four patients were randomly assigned to receive remifentanil 0.75 micro g/kg in bolus, followed by a continuous infusion of 0.075 micro g x kg(-1) x min(-1) (Group L), or remifentanil 1.5 micro g/kg in bolus, followed by a continuous infusion of 0.15 micro g x kg(-1) x min(-1) (Group H). All patients were premedicated with midazolam 0.05 mg/kg IV and glycopyrrolate 0.2 mg IV. Both dosage regimens ensured patient comfort and sedation. Discomfort did not differ between groups. Patients in Group H were sedated more profoundly. Hemodynamic stability was maintained with both remifentanil doses. Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.
authors.affiliation: *Department of Anesthesiology and General Intensive Care, University of Vienna; and †Ludwig-Boltzmann-Institute for Anesthesiology and Intensive Care, Vienna, Austria.
authors.forename: Anette-Marie
authors.initials: AM
authors.lastname: Machata
authors.forename: Christopher
authors.initials: C
authors.lastname: Gonano
authors.forename: Andrea
authors.initials: A
authors.lastname: Holzer
authors.forename: Dorothea
authors.initials: D
authors.lastname: Andel
authors.forename: Christian K
authors.initials: CK
authors.lastname: Spiss
authors.forename: Michael
authors.initials: M
authors.lastname: Zimpfer
authors.forename: Udo M
authors.initials: UM
authors.lastname: Illievich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal; D008297:Male; D011939:Mental Recall / Q000187:drug effects; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D002245:Carbon Dioxide; D000077208:Remifentanil