Machata Anette-Marie, Gonano Christopher, Holzer Andrea, Andel Dorothea, Spiss Christian K, Zimpfer Michael, Illievich Udo M
*Department of Anesthesiology and General Intensive Care, University of Vienna; and †Ludwig-Boltzmann-Institute for Anesthesiology and Intensive Care, Vienna, Austria.
Anesth Analg. 2003 Sep;97(3):904-908. doi: 10.1213/01.ANE.0000074089.39416.F1.
Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. For that reason, we compared two different dosage regimens. Twenty-four patients were randomly assigned to receive remifentanil 0.75 micro g/kg in bolus, followed by a continuous infusion of 0.075 micro g x kg(-1) x min(-1) (Group L), or remifentanil 1.5 micro g/kg in bolus, followed by a continuous infusion of 0.15 micro g x kg(-1) x min(-1) (Group H). All patients were premedicated with midazolam 0.05 mg/kg IV and glycopyrrolate 0.2 mg IV. Both dosage regimens ensured patient comfort and sedation. Discomfort did not differ between groups. Patients in Group H were sedated more profoundly. Hemodynamic stability was maintained with both remifentanil doses. Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.
清醒状态下经鼻纤维支气管镜引导气管插管需要一种麻醉管理方式，以确保患者有足够的舒适度、良好的插管条件以及稳定的血流动力学。短效且易于滴定的镇痛药是这种操作的理想选择。在本研究中，我们的目的是确定瑞芬太尼用于清醒状态下经鼻纤维支气管镜引导气管插管的合适剂量方案。因此，我们比较了两种不同的剂量方案。24例患者被随机分配，分别接受静脉推注瑞芬太尼0.75μg/kg，随后以0.075μg·kg⁻¹·min⁻¹的速度持续输注（L组），或静脉推注瑞芬太尼1.5μg/kg，随后以0.15μg·kg⁻¹·min⁻¹的速度持续输注（H组）。所有患者均预先静脉注射咪达唑仑0.05mg/kg和格隆溴铵0.2mg。两种剂量方案均确保了患者的舒适度和镇静效果。两组之间的不适感无差异。H组患者的镇静程度更深。两种瑞芬太尼剂量均维持了血流动力学稳定。所有患者的插管条件均良好，且两组之间相当。与小剂量方案相比，大剂量方案未带来任何额外益处。因此，对于清醒状态下经鼻纤维支气管镜引导气管插管，我们推荐静脉推注瑞芬太尼0.75μg/kg，随后以0.075μg·kg⁻¹·min⁻¹的速度持续输注，并补充咪达唑仑0.05mg/kg。
