Remifentanil-TCI and propofol-TCI for conscious sedation during fibreoptic intubation in the acromegalic patient
| Autor: | Cafiero T, Gargiulo G, N. Mennella, L. M. Cavallo, Felice Esposito, Frangiosa A, P. Cappabianca, G. Fraioli |
|---|---|
| Přispěvatelé: | T., Cafiero, Esposito, Felice, G., Fraioli, G., Gargiulo, A., Frangiosa, Cavallo, LUIGI MARIA, N., Mennella, Cappabianca, Paolo |
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Mean arterial pressure medicine.medical_treatment Sedation Remifentanil Conscious Sedation Blood Pressure Piperidines Heart Rate Intubation Intratracheal Medicine Intubation Humans Prospective Studies Infusions Intravenous Propofol Aged Analysis of Variance business.industry Tracheal intubation Middle Aged Surgery Anesthesiology and Pain Medicine Patient Satisfaction Anesthesia Acromegaly Mental Recall Midazolam Premedication Female medicine.symptom business Anesthetics Intravenous medicine.drug |
| Popis: | BACKGROUND AND OBJECTIVE To evaluate the use of remifentanil-propofol administered as target-controlled infusion during awake fibreoptic intubation for anticipated difficult tracheal intubation in acromegalic patients. METHOD In all, 20 consecutive acromegalic patients underwent elective endonasal endoscopic transsphenoidal pituitary surgery. After premedication with midazolam 0.03 mg kg(-1), initially a target-controlled infusion of remifentanil 1.0 ng mL(-1) and propofol 1.5 microg mL(-1) was started. The fibreoptic intubation was performed by the same physician experienced with the fibreoptic technique. During the fibreoptic procedure the target concentrations of remifentanil and propofol ranged between 1.0 and 5.0 ng mL(-1), and between 1.5 and 3.5 microg mL(-1), respectively. Changes in heart rate and mean arterial pressure were recorded during airway manipulation, during tracheal intubation, and at 1 and 3 min after. On the first postoperative day, patient recall and level of discomfort during fibreoptic intubation were evaluated. RESULTS Endotracheal intubation was efficaciously and quickly secured in all patients. A significant increase in mean arterial pressure and heart rate was recorded only during tracheal intubation (P < 0.05). Oxygenation was sufficient and no bradypnea or apnoea was recorded. All patients later described their anaesthetic experience as satisfactory. During fibreoptic intubation, remifentanil (ng mL(-1)) and propofol (microg mL(-1)) mean effect-site concentrations were 3.2 +/- 0.3 and 2.0 +/- 1.0, respectively. CONCLUSION Remifentanil and propofol target-controlled infusion provided satisfactory conscious sedation allowing for successful oral fibreoptic intubation in acromegalic patients with no recall. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|