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Remifentanil-TCI and propofol-TCI for conscious sedation during fibreoptic intubation in the acromegalic patient

Published online by Cambridge University Press:  01 August 2008

T. Cafiero ,
F. Esposito ,
G. Fraioli ,
G. Gargiulo ,
A. Frangiosa ,
L. M. Cavallo ,
N. Mennella  and
P. Cappabianca
T. Cafiero*
Affiliation:
A. Cardarelli Hospital, Burn Center and Hyperbaric Center, Postoperative Intensive Care, Department of Anaesthesia, University “Federico II”, Naples, Italy
F. Esposito
Affiliation:
Department of Neurosurgery, University “Federico II”, Naples, Italy
G. Fraioli
Affiliation:
Department of Bronchoscopy, University “Federico II”, Naples, Italy
G. Gargiulo
Affiliation:
Department of Anaesthesia, University “Federico II”, Naples, Italy
A. Frangiosa
Affiliation:
A. Cardarelli Hospital, Burn Center and Hyperbaric Center, Postoperative Intensive Care, Department of Anaesthesia, University “Federico II”, Naples, Italy
L. M. Cavallo
Affiliation:
Department of Neurosurgery, University “Federico II”, Naples, Italy
N. Mennella
Affiliation:
Department of Anaesthesia, University “Federico II”, Naples, Italy
P. Cappabianca
Affiliation:
Department of Neurosurgery, University “Federico II”, Naples, Italy
*
Correspondence to: Cafiero Tullio, Department of Anaesthesia, Postoperative Intensive Care, Burn Center and Hyperbaric Center, A. Cardarelli Hospital, via A. Cardarelli, 9 Napoli 80131, Italy. E-mail: [email protected]; Tel/Fax: +390815456294
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Summary

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 μg 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 μg 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 (μg 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.

Keywords

REMIFENTANILPROPOFOL, target-controlled infusionACROMEGALYINTUBATION INTRATRACHEAL, fibreoptic
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 670 - 674
Copyright
Copyright © European Society of Anaesthesiology 2008

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