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ANESTHETIC PHARMACOLOGY

A Comparison of Propofol and Remifentanil Target-Controlled Infusions to Facilitate Fiberoptic Nasotracheal Intubation

Alexandre Lallo, MD, FRCPC^*, Valerie Billard, MD^*, and Jean-Louis Bourgain, MD^*

From the *Department of Anesthesiology, Institut Gustave Roussy, Villejuif, France; and Department of Anesthesiology, Centre Hospitalier de l’université de Montréal, Hopital Notre-Dame. Montréal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Alexandre Lallo, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal (Quebec), H2L-4M1, Canada. Address e-mail to a.lallo{at}umontreal.ca.

INTRODUCTION: Successful fiberoptic intubation requires both patient comfort and good intubating conditions. In this study we compared the efficacy and ease of titration of propofol (P) and remifentanil (R) target-controlled infusions (TCI) during fiberoptic intubation.

METHODS: Sixty patients requiring fiberoptic nasotracheal intubation were randomized to receive (P) or (R) effect-site TCI. After topical anesthesia, TCI was set to 2.5 µg/mL (P) or 1.5 ng/mL (R) then titrated by 1 µg/mL (P) or 0.5 ng/mL (R) increments according to patient reactions. Targets and level of sedation were recorded at each step as well as total dose, number of adjustments, intubating conditions, discomfort, and recall assessed after surgery.

RESULTS: Intubation duration, success rate, and number of increments did not differ between groups. Intubating conditions were good in both groups, with a final target of 3.9 ± 1.4 µg/mL (P) or 2.4 ± 0.8 ng/mL (R) (total dose 142 ± 55 mg and 77 ± 27 µg, respectively). There was no difference in minimal Spo₂ and maximal end-tidal CO₂ after intubation. No laryngospasm or significant hemodynamic instability was observed. There was one major hypoxemia due to obstructive apnea in group P. Patients in group P were significantly more sedated and less cooperative. Recall was more frequent in group R, whereas pain scores were equally low in both groups.

CONCLUSION: Both R and P TCI can be rapidly titrated to achieve good intubating conditions and patient comfort. R allows for more patient cooperation, making it safer when spontaneous ventilation is paramount.

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