title: Remifentanil, ketamine, and propofol in awake nasotracheal fiberoptic intubation in temporomandibular joint ankylosis surgery.
abstract: BACKGROUND
  Nasotracheal intubation of patients with temporomandibular joint (TMJ) ankylosis is a challenge for anesthesiologists. Awake fiberoptic intubation (AFOI) is the safest technique in patients with difficult airway. This study compares 3 different techniques of conscious sedation during AFOI in patients with TMJ ankylosis.
  
  
  METHODS
  This study comprised 54 patients, American Society of Anesthesiologists physical status 1, scheduled for TMJ surgery. The patients were randomly allocated to remifentanil group (n = 18, 0.75 μg/kg over 30 seconds), ketamine group (n = 18, 0.25 mg/kg over 30 seconds), or propofol group (n = 18, 0.5 mg/kg over 30 seconds) for conscious sedation. The main determinants affecting the patient's outcome included intubation time, intubation conditions, and patient discomfort, which were determined by scoring system. In addition, postoperative patient dissatisfaction, hemodynamic stability, and respiratory impairment were measured.
  
  
  RESULTS
  Intubation times were significantly different between groups (P < 0.001), where remifentanil had the shortest time (30.28 seconds). Intubation conditions (scores 0-3) were significantly different between groups (P < 0.001).In this context, remifentanil had score 3 (2-3), which was higher compared with 2 (1-3) for ketamine and 2 (1-2) for propofol. Patient discomfort score was lowest in the remifentanil group. Hemodynamic stability was maintained within groups, and its changes were not significant (P > 0.05). Postoperative patient's dissatisfaction was observed in 2, 3, and 5 patients in remifentanil, ketamine, and propofol groups, respectively. Respiratory impairment (apnea) recorded lowest in the remifentanil group.
  
  
  CONCLUSIONS
  Remifentanil was the best agent for AFOI, because it provided shorter intubation time, better intubation conditions, and least patient's complaint.Iranian registry no.: IRCT 201208061674N4 (www.irct.ir).
authors.affiliation: From the *Department of Craniomaxillofacial Surgery, †Shiraz University of Medical Science, Shiraz; and ‡Research Center for Social Determinants of Health, Jahrom University of Medical Science, Jahrom, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Eftekharian
authors.forename: Kamal
authors.initials: K
authors.lastname: Zarei
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Arabion
authors.forename: Seyed Taghi
authors.initials: ST
authors.lastname: Heydari
mesh_terms: D000293:Adolescent; D000328:Adult; D000777:Anesthetics; D000844:Ankylosis / Q000601:surgery*; D016292:Procedural Sedation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D006993:Hypnotics and Sedatives; D007442:Intubation, Intratracheal / Q000379:methods*; D007649:Ketamine; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D055815:Young Adult
chemical_list: D000777:Anesthetics; D006993:Hypnotics and Sedatives; D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil; D015742:Propofol