Target-Controlled Infusion of Remifentanil to Provide Analgesia for Awake Nasotracheal Fiberoptic Intubations in Cervical Trauma Patients

Abstract

BACKGROUND: Awake fiberoptic tracheal intubation is the best choice for situations in which neck movement is limited or hazardous, and remifentanil is one of the most popular drugs that are used in these circumstances. We administered remifentanil with target-controlled and manually controlled infusion techniques in two groups of patients who had cervical trauma and semielective maxillofacial surgery. METHODS: Twenty-two patients were enrolled and randomly assigned to two groups. Bronchoscopy data were gathered in four data points. In the target-controlled infusion (TCI) group, patients received 0.8 ng · mL remifentanil as effect-site target, and in the manually controlled group, patients received remifentanil with a loading dose of 0.75 μg · kg and 0.075 μg · kg · min as maintenance. Patients were evaluated separately for recall and pain during procedure 24 hours after operation by visual analog scale. Comparison of vital signs was performed using Mann-Whitney U test. Fischer's exact test was used to analyze quantitative data when appropriate. RESULTS: Preparation time was shorter in the TCI group, and remifentanil effect-site targets were higher in the TCI group. Vital signs were more stable in the TCI group. Levels of sedation were comparable in both groups. Recall and pain during endoscopy were more common in the manually controlled infusion group. CONCLUSION: Remifentanil infusion could be recommended to provide good conscious sedation in procedures such as awake nasotracheal intubation, but target-controlled remifentanil infusion seems to provide better conditions compared with manually controlled remifentanil infusion and is easier to use.