The comparison of feasibility and safety on fiberoptic guided intubation under conscious sedation with remifentanil and propofol

Title
The comparison of feasibility and safety on fiberoptic guided intubation under conscious sedation with remifentanil and propofol
Author(s)
지대림이혜미사공준
Keywords
propofol; remifentanil; adult; apnea; article; bradycardia; bradypnea; breathing rate; clinical article; comparative study; conscious sedation; controlled study; disease severity; drug safety; endotracheal intubation; feasibility study; female; gastrointestinal symptom; human; incidence; male; prevalence; Ramsay Sedation Scale; randomized controlled trial; scoring system
Issue Date
201309
Citation
Korean Journal of Anesthesiology, v.65, no.3, pp.215 - 220
Abstract
Background: Oropharyngeal manipulation is problematic when patients have a gag reflex. Sedation can suppress gag reflex, but can cause serious airway problems. We compared remifentanil (Group R) and propofol (Group P) in terms of cooperation and loss of gag reflex, while drugs were administered incrementally using target controlled infusion (TCI). Methods: Fifty seven patients who required awake fiberoptic intubation were randomized to Group R or Group P. After measurement of baseline gag trigger point index (GTPI), TCI was set to effect-site concentration (Ce) of 1 ng/ml (Group R) or 1 ��g/ml (Group P), then titrated by 0.5 increment until GTPI score reached 0. The incidence of drop-out and decreased cooperation, Ramsay sedation scale (RSS) and Ce at loss of GR, and complications were assessed. Results: Seven patients were dropped out in Group P due to deep sedation and disobedient behavior, but none in Group R (P = 0.015). Gag reflex suppressed as RSS increased in both groups (P < 0.001), however, the incidence of elimination of gag reflex clustered at RSS 2 in Group R (P < 0.001), whereas it was evenly distributed in Group P (P = 0.20). The incidence of patients who were spontaneously roused (gag reflex elimination at RSS 1 and 2) were higher in Group R than in Group P (P = 0.002). Conclusions: Deep sedation and impaired cooperation were observed only in Group P and spontaneously roused patients were higher in Group R, suggesting that remifentanil is more suitable for cooperative elimination of GR. ? the Korean Society of Anesthesiologists, 2013.
URI
http://hdl.handle.net/YU.REPOSITORY/28961http://dx.doi.org/10.4097/kjae.2013.65.3.215
ISSN
2005-6419
Appears in Collections:
의과대학 > 마취통증의학교실 > Articles
의과대학 > 예방의학교실 > Articles
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