Effects of remifentanil in awake blind intubation on respiration and hemodynamics of patients with anticipated difficult intubation

Objective To compare the effects of remifentanil and fentanyl on the respiratory and cardiovascu lar functions of patients undergoing difficult airway awake intubation.Methods Forty patients(ASA classⅠtoⅡ) undergoing selective oral and maxillofacial surgery were enrolled in this study,who all had a history of difficult in- tubation or showed signs of difficult airway in preoperative examination.The patients were randomly assigned into two equal groups to receive fentanyl(2-3μg/kg)+midazolam(1 mg,fentanyl group) or remifentanil(1- 2μg/kg)+midazolam(1 mg,remifentanil group) before awake blind intubation with tracheal anesthesia (3 mL 2%lidocaine through the cricothyroid membrane).Immediately after the intubation,the patients were given propofol(1.5- 2.0 mg/kg) and rocuronium(0.6 mg/kg) infusion with 2%sevoflurane inhalation before mandato- ry ventilation.The respiration,operative time for intubation and success rate of intubation and the anesthetic effects were recorded.Results Remifentanil produced stronger effect of respiratory depression,which could be re- lieved by oxygen administration.Compared with the baseline values,the mean arterial pressure(MAP) of both groups recorded 3 rain after general anesthesia induction was significantly lowered(P0.05),but the other hemo- dynamic parameters showed no significant variations(P0.05),nor was significant difference noted in these pa- rameters between the two groups(P0.05).The intubation processes in both groups were uneventful,and the success rate reached 100%.With comparable operative time for intubation between the two groups(P0.05), remifentanil resulted in a significantly higher rate of grade 1 sedation (75%) than fentanyl (40%,P0.05). Conclusion Appropriate application of remifentanil can be safe and effective for awake blind intubation.(Shanghai MedJ,2008,31:116-118)