瑞芬太尼、氯胺酮和丙泊酚用于颞下颌关节强直手术清醒状态下经鼻纤维支气管镜插管

Remifentanil, ketamine, and propofol in awake nasotracheal fiberoptic intubation in temporomandibular joint ankylosis surgery.

作者信息

Eftekharian Hamid Reza, Zarei Kamal, Arabion Hamid Reza, Heydari Seyed Taghi

机构信息

From the *Department of Craniomaxillofacial Surgery, †Shiraz University of Medical Science, Shiraz; and ‡Research Center for Social Determinants of Health, Jahrom University of Medical Science, Jahrom, Iran.

出版信息

J Craniofac Surg. 2015 Jan;26(1):206-9. doi: 10.1097/SCS.0000000000001243.

DOI:10.1097/SCS.0000000000001243

PMID:25478975

Abstract

BACKGROUND

Nasotracheal intubation of patients with temporomandibular joint (TMJ) ankylosis is a challenge for anesthesiologists. Awake fiberoptic intubation (AFOI) is the safest technique in patients with difficult airway. This study compares 3 different techniques of conscious sedation during AFOI in patients with TMJ ankylosis.

METHODS

This study comprised 54 patients, American Society of Anesthesiologists physical status 1, scheduled for TMJ surgery. The patients were randomly allocated to remifentanil group (n = 18, 0.75 μg/kg over 30 seconds), ketamine group (n = 18, 0.25 mg/kg over 30 seconds), or propofol group (n = 18, 0.5 mg/kg over 30 seconds) for conscious sedation. The main determinants affecting the patient's outcome included intubation time, intubation conditions, and patient discomfort, which were determined by scoring system. In addition, postoperative patient dissatisfaction, hemodynamic stability, and respiratory impairment were measured.

RESULTS

Intubation times were significantly different between groups (P < 0.001), where remifentanil had the shortest time (30.28 seconds). Intubation conditions (scores 0-3) were significantly different between groups (P < 0.001).In this context, remifentanil had score 3 (2-3), which was higher compared with 2 (1-3) for ketamine and 2 (1-2) for propofol. Patient discomfort score was lowest in the remifentanil group. Hemodynamic stability was maintained within groups, and its changes were not significant (P > 0.05). Postoperative patient's dissatisfaction was observed in 2, 3, and 5 patients in remifentanil, ketamine, and propofol groups, respectively. Respiratory impairment (apnea) recorded lowest in the remifentanil group.

CONCLUSIONS

Remifentanil was the best agent for AFOI, because it provided shorter intubation time, better intubation conditions, and least patient's complaint.Iranian registry no.: IRCT 201208061674N4 (www.irct.ir).

摘要

背景

对颞下颌关节（TMJ）强直患者进行鼻气管插管对麻醉医生来说是一项挑战。清醒纤维支气管镜插管（AFOI）是气道困难患者最安全的技术。本研究比较了TMJ强直患者在AFOI期间3种不同的清醒镇静技术。

方法

本研究纳入54例美国麻醉医师协会身体状况1级、计划行TMJ手术的患者。患者被随机分为瑞芬太尼组（n = 18，30秒内给予0.75μg/kg）、氯胺酮组（n = 18，30秒内给予0.25mg/kg）或丙泊酚组（n = 18，30秒内给予0.5mg/kg）进行清醒镇静。影响患者结局的主要决定因素包括插管时间、插管条件和患者不适，通过评分系统确定。此外，还测量了术后患者的不满意程度、血流动力学稳定性和呼吸功能损害。

结果

各组间插管时间有显著差异（P < 0.001），其中瑞芬太尼组时间最短（30.28秒）。插管条件（0 - 3分）在各组间有显著差异（P < 0.001）。在此情况下，瑞芬太尼组评分为3分（2 - 3分），高于氯胺酮组的2分（1 - 3分）和丙泊酚组的2分（1 - 2分）。瑞芬太尼组患者不适评分最低。各组内均维持了血流动力学稳定性，其变化不显著（P > 0.05）。瑞芬太尼组、氯胺酮组和丙泊酚组分别有2例、3例和5例患者术后表示不满意。瑞芬太尼组记录的呼吸功能损害（呼吸暂停）最少。