Korean J Anesthesiol.  2013 Sep;65(3):215-220. 10.4097/kjae.2013.65.3.215.

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

• Lee HM
• Sakong J
• Jee DL

• KMID: 2239720
• DOI: http://doi.org/10.4097/kjae.2013.65.3.215

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 microg/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.

Keyword

Gag reflex; Propofol; Remifentanil

MeSH Terms

Conscious Sedation
Deep Sedation
Humans
Incidence
Intubation
Piperidines
Propofol
Reflex
Trigger Points
Piperidines
Propofol