中华医学杂志（英文版）2009，Vol.122Issue(13)：1507-1512,6.DOI:10.3760/cma.j.issn.0366-6999.2009.13.006
Median effective dose of remifentanil for awake laryngoscopy and intudation
Median effective dose of remifentanil for awake laryngoscopy and intudation
XU Ya-chao 1XUE Fu-shan 1LUO Mad-ping 1YANG Quan-yong 1LIAO Xu 1LU Yi 1ZHANG Yan-ming1
作者信息
- 1. Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China
- 折叠
摘要
Abstract
Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose (ED50) of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation.Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon's up-and-down method. Patient's reaction score at laryngoscopy and an Observer's Assessment of Alertness/Sedation Scale (OAA/S) were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. EDso of remifentanil was calculated by the modified Dixon up-and-clown method, and the probit analysis was then used to confirm the results obtained from the modified Dixon's up-and-down method. In the patients who were scored as "accept", patient's OAA/S and reaction scores at different observed points, intubating condition score and patient's tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted.Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon's up-and-down method was (0.62±0.02) pg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg (95% Cl, 0.54-0.70) and 0.83 μg/kg (95% Cl, 0.73-2.59), respectively. Nineteen patients who were scored as =accept" had an OAA/S of 15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was1.8±0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heartrate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation.Conclusions When combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED50 of remifentanil for successful awake laryngoscopy and intubation is 0.62 μg/kg in bolus followed by continuous infusion of 0.062 pg.kg-1.min-1. This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.关键词
laryngoscopy/ awake intubation/ remifentanil/ median effective dose/ sedation and analgesiaKey words
laryngoscopy/ awake intubation/ remifentanil/ median effective dose/ sedation and analgesia分类
医药卫生引用本文复制引用
XU Ya-chao,XUE Fu-shan,LUO Mad-ping,YANG Quan-yong,LIAO Xu,LU Yi,ZHANG Yan-ming..Median effective dose of remifentanil for awake laryngoscopy and intudation[J].中华医学杂志（英文版）,2009,122(13):1507-1512,6.
