title: Tramadol combined with fentanyl in awake endotracheal intubation.
abstract: OBJECTIVE
  To explore the feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation.
  
  
  METHODS
  Using Dixon's up-and-down sequential design, the study enrolled patients from each of the 20-49, 50-60 and 70-and-above age groups scheduled for elective surgery under general anesthesia. The feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation, guided by fiberoptic bronchoscopy, were verified.
  
  
  RESULTS
  After intravenous injection with fentanyl 2.2 μg/kg and tramadol 2.0 mg/kg in the 20-49 age group, fentanyl 1.6 μg/kg and tramadol 1.9 mg/kg in the 50-69 age group and fentanyl 1 μg/kg and tramadol 1.8 mg/kg in those at the age of 70 or above, the patients achieved conscious sedation without obvious respiratory depression. Meanwhile, under these dosages, the patients could easily tolerate the thyrocricocentesis airway surface anesthesia and fiberoptic bronchoscope guided tracheal intubation. Postoperative follow-up showed that most patients had memory of the intubation process but without significant discomfort. No awake endotracheal intubation-related side effect was noted.
  
  
  CONCLUSIONS
  Fiberoptic bronchoscope guided nasotracheal intubation can be successfully completed with background administration of fentanyl and tramadol. However, the specific dosages need to be tailored in different age of patients.
authors.affiliation: Institution of Pharmacology, Central South University, China; ; Department of Anesthesiology, the 3rd Xiangya Hospital of Central South University, China.
authors.forename: Sai-Ying
authors.initials: SY
authors.lastname: Wang
authors.forename: Yang
authors.initials: Y
authors.lastname: Mei
authors.forename: Hui
authors.initials: H
authors.lastname: Sheng
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.forename: Rui
authors.initials: R
authors.lastname: Han
authors.forename: Cheng-Xuan
authors.initials: CX
authors.lastname: Quan
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Hu
authors.forename: Wen
authors.initials: W
authors.lastname: Ouyang
authors.forename: Zhao-Qian
authors.initials: ZQ
authors.lastname: Liu
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Duan
keywords: Awake endotracheal intubation; fentanyl; fiberoptic bronchoscope; nasotracheal intubation; tramadol