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Awake Nasotracheal Fiberoptic Intubation: Patient Comfort, Intubating Conditions, and Hemodynamic Stability During Conscious Sedation with Remifentanil

2003; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1213/01.ane.0000074089.39416.f1

1526-7598

A.-M. Machata, C. Gonano, A. Holzer, D. Andel, Christian K. Spiss, M. Zimpfer, U. M. Illievich,

Intensive Care Unit Cognitive Disorders

In Brief 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 μg/kg in bolus, followed by a continuous infusion of 0.075 μg · kg−1 · min−1 (Group L), or remifentanil 1.5 μg/kg in bolus, followed by a continuous infusion of 0.15 μg · kg−1 · 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 μg/kg in bolus followed by continuous infusion of 0.075 μg · kg−1 · min−1, supplemented with midazolam 0.05 mg/kg. IMPLICATIONS: Short-acting, and therefore easily titratable, analgesics are excellent choices for awake nasotracheal fiberoptic intubation. We found that remifentanil 0.75 μg/kg in bolus followed by continuous infusion of 0.075 μg · kg−1 · min−1 supplemented with midazolam provided adequate patient comfort, sedation, and intubating conditions.