Combined target-controlled infusion of Propofol and Remifentanil for anesthesia induction during tracheal intubation under fibreoptic bronchoscope

Abstract

Objective To evaluate the feasibility of combined Propofol and Remifentanil targetcontrolled infusion (TCI) for anesthesia induction during tracheal intubation under fibreoptic bronchoscope (FOB) , and to compare the outcomes with manually controlled infusion (MCI). Methods Between December 2009 and January 2010, 24 patients registered to our hospital, who were predictedly without difficult airway and scheduled for elective surgery under general anesthesia with tracheal intubation, were randomly divided into two groups: TCI group and MCI group (n=12 each). FOB intubation was completed under TCI or MCI Propofol and Remifentanil induction respectively. Blood pressure(BP), heart rate(HR),SPO2, and Narcotrend index (NI)were used to monitor anesthetic depth during the induction. In addition,time to loss of eonciousness (LOC), intubation time, intubation score, anesthetic dosage and adverse effects were recorded. Results LOC and intubation time of TCI group were significantly shorter than those of MCI group [ (2.2±0.5) vs (5.3±2.3)min and (7.7±3.9) vs (12.5±4.5)min, respectively,P＜0.01 ]. No significant differences in intubation score, Propofol and Remifentanil dosage were found between the two groups. BP and HR decreased significantly after induction in both groups (P＜0.05), with MCI group showing greater decrease in HR after intubation compared to TCI group(P＜0.05). NI of TCI group dropped faster than that of MCI group (P＜0.05) . Neither significant adverse effects nor recall about intubation was noted.Conclusions Propofol and Remifentanil induction can be safe and effective for FOB intubation in the patients without general anesthesia contraindications. Compared with MCI mode, TCI mode can provide faster induction and intubation with more stable haemodynamics. Key words: Intubation,intratracheal; Bronchoscopy; Propofol; Remifentanil; Anesthesia