Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases

Abstract

BackgroundThe tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation.Case presentationTwelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons’ verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures.ConclusionsDuring the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion.

Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck

“…The limitation of our method is that we did not use short-acting sedatives/opioids, such as remifentanil or midazolam for sedation in this case, because of detrimental effects, such as muscle rigidity, hypoxemia, respiratory arrest, or hemodynamic fluctuations requiring treatment [28], and ketamine or sevoflurane administration during procedure because of awake FFB intubation effort.…”