Evaluation of remifentanil as single drug for awake fiberoptic intubation

Abstract

Remifentanil in high doses, as the single agent for patient preparation for awake fiberoptic intubation seems to improve intubating conditions, quality and reliability of the procedure. However, a higher incidence of recall is to be expected.

Conscious sedation for awake fibreoptic intubation: a review of the literature

“…The authors went on to randomize a further 74 patients requiring nasal intubation for elective maxillofacial surgery to undergo an AFOI with either a relatively high dose of remifentanil (0.25-0.5 lgÁkg -1 Á min -1 , as required) or boluses of fentanyl and midazolam. 28 Hemodynamic changes were lower and tolerance of the procedure was higher in the remifentanil group. Unsurprisingly, respiratory depression was very common, but even at these doses, was always corrected by verbal commands to breathe.…”

“…33 Results of studies that have looked at remifentanil as the primary agent for AFOI are generally in agreement that patients usually have a higher incidence of recall of the procedure. [10][11][12]28,29 Use of remifentanil is associated with an incidence of recall of 50-100% when used as a sole agent and even in high doses or when used in conjunction with midazolam. Although patients had a good recall of the event in all of the above studies, it is interesting to point out that they did not perceive the event to be an unpleasant experience, and they were not distressed by it.…”

Extubation of the surgically resected airway — a role for remifentanil and propofol infusions

“…20,21 A continuous infusion of remifentanil between 0.05 to 0.075 µg·kg -1 ·min -1 has been demonstrated to provide good intubating conditions. 18,19 When remifentanil was used alone, a high incidence of recall was reported. 18 However, neither propofol nor remifentanil have been described to facilitate tracheal extubation after airway surgery.…”

“…18,19 When remifentanil was used alone, a high incidence of recall was reported. 18 However, neither propofol nor remifentanil have been described to facilitate tracheal extubation after airway surgery.…”

“…[17][18][19] Both of these drugs can suppress the cardiovascular response during emergence. 20,21 A continuous infusion of remifentanil between 0.05 to 0.075 µg·kg -1 ·min -1 has been demonstrated to provide good intubating conditions.…”