Bronchoskopische Intubation in Remifentanil-Propofol-Sedierung

Abstract

Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.

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

“…No patient became hypoxic, and the heart rate and blood pressure remained within 30% of baseline in all but one. 9 A greater body of published work has focused on targetcontrolled infusion (TCI) of propofol for AFOI, either as the sole agent or in combination with remifentanil. [10][11][12][13] Targetcontrolled infusions of propofol for AFOI have been assessed in three RCTs providing level 1 evidence comparing it with remifentanil (Table 2) 10-12 and in one RCT comparing it with dexmedetomidine.…”

“…9,10,[14][15][16] More recently, case reports have described the concurrent use of propofol TCI with remifentanil TCI for AFOI [14][15][16] Authors describing the combined use of TCI propofol and remifentanil for AFOI have reported mean effect-site concentrations during the procedure of 0.8-2.0 lgÁmL -1 and 1.5-3.2 ngÁmL -1 , respectively. Although there is no evidence supporting the superiority of TCI propofol over a fixed rate infusion in the setting of an AFOI, it is safe to say that a TCI has a more consistent pharmacodynamic effect and may allow for a more predictable level of sedation to be maintained.…”

Remifentanil sedation for awake fibreoptic intubation with limited application of local anaesthetic in patients for elective head and neck surgery*

“…Remifentanil has previously been used as a sole agent and also in combination with propofol and midazolam for sedation for awake fibreoptic intubation [2,3,[5][6][7]. Neidhardt and colleagues studied 40 patients sedated with propofol 2 mg.kg )1 .h )1 and remifentanil commenced at 0.05 lg.kg )1 .min )1 and adjusted thereafter according to respiratory rate [5].…”

“…Neidhardt and colleagues studied 40 patients sedated with propofol 2 mg.kg )1 .h )1 and remifentanil commenced at 0.05 lg.kg )1 .min )1 and adjusted thereafter according to respiratory rate [5]. Intubation was successful in all patients and oxygen saturation remained above 93%.…”

“…Key requirements of this technique include adequate preparation of the patient, whilst maintaining patient safety and minimising discomfort. In addition to topical anaesthesia of the airway, a number of drugs have been described to provide sedation for this procedure [1][2][3][4][5][6][7].…”