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Target-controlled infusion of propofol for fibreoptic intubation

Published online by Cambridge University Press:  11 July 2005

E. Knolle ,
M. J. Oehmke ,
B. Gustorff ,
K. Hellwagner  and
H. G. Kress
E. Knolle
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
M. J. Oehmke
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
B. Gustorff
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
K. Hellwagner
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
H. G. Kress
Affiliation:
University of Vienna, Department of Anaesthesiology and General Intensive Care (B), Vienna, Austria
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Extract

Summary

Background and objective: In a retrospective study, we examined the suitability of a departmental clinical protocol for anaesthesia induction with target-controlled infusion of propofol developed for fibreoptic intubation in spontaneously breathing patients scheduled for outpatient oral surgery at the dental clinic of the Vienna University Hospital.

Methods: Propofol was administered using target-controlled infusion (Diprifusor®) at increasing target plasma concentrations starting at 2.5 μg mL−1. After 10 min, an intravenous dose of alfentanil (5–10 μg kg−1) was given for pain reduction. After a further 2 min, the patient was evaluated for response to auditory stimulation. If unresponsive, fibreoptic intubation was performed, otherwise the target concentration was increased by 0.2 μg mL−1 every 2 min until non-responsiveness was attained.

Results: Tracheal intubation was successful in all patients without any haemodynamic instability. However, one patient required facemask ventilation for 2 min. No patient was aware of intubation. The plasma concentration required for non-responsiveness was 2.8 ± 0.4 μg mL−1 (mean ± SD).

Conclusions: When using a target-controlled infusion of propofol, fibreoptic intubation can be performed with complete amnesia of the procedure for the patient. However, assisted ventilation of the lungs may be necessary as spontaneous ventilation may cease.

Keywords

ANAESTHETICS, INTRAVENOUS, propofolINTUBATION, INTRATRACHEALOPTICS, fibreopticsPHARMACOKINETICS, target-controlled infusionSEDATION, amnesia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 7 , September 2003 , pp. 565 - 569
Copyright
© 2003 European Society of Anaesthesiology

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References

Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology 1991; 75: 1087–1110.Google Scholar
McGuire G, El-Beheiry H. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures. Can J Anaesth 1999; 46: 176–178.Google Scholar
Wulf H, Brinkmann G, Rautenberg M. Management of the difficult airway. A case of failed fiberoptic intubation. Acta Anaesthesiol Scand 1997; 41: 1080–1082.Google Scholar
Shaw IC, Welchew EA, Harrison BJ, Michael S. Complete airway obstruction during awake fibreoptic intubation. Anaesthesia 1997; 52: 582–585.Google Scholar
Morris IR. Fibreoptic intubation. Can J Anaesth 1994; 41: 996–1007.Google Scholar
Marian F, Spiss CK, Hiesmayr M, Draxler V. Monitoring fiberoptic intubation using non-invasive pulse oximetry. Anaesthesist 1985; 34: 630–635.Google Scholar
Kenny GN. Target-controlled anaesthesia: concepts and first clinical experiences. Eur J Anaesthesiol 1997; 13 (Suppl 15): 29–31.Google Scholar
Irwin MG, Thompson N, Kenny GN. Patient-maintained propofol sedation. Assessment of a target-controlled infusion system. Anaesthesia 1997; 52: 525–530.Google Scholar
Ludbrook GL, Hitchcock M, Upton RN. The difficult airway: propofol infusion as an alternative to gaseous induction. Anaesth Intensive Care 1997; 25: 71–73.Google Scholar
Smith M, Calder I, Crockard A, Isert P, Nicol ME. Oxygen saturation and cardiovascular changes during fibreoptic intubation under general anaesthesia. Anaesthesia 1992; 47: 158–161.Google Scholar
Erb T, Hampl KF, Schurch M, Kern CG, Marsch SC. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg 1999; 89: 1292–1295.Google Scholar
Neidhart G, Bremerich DH, Kessler P. Fiberoptic intubation during remifentanil propofol sedation. Anaesthesist 2001; 50: 242–247.Google Scholar
Vuyk J. TCI: supplementation and drug interactions. Anaesthesia 1998; 53: 35–41.Google Scholar
Casati A, Fanelli G, Casaletti E, Cedrati V, Veglia F, Torri G. The target plasma concentration of propofol required to place laryngeal mask versus cuffed oropharyngeal airway. Anesth Analg 1999; 88: 917–920.Google Scholar
Taylor IN, Kenny GN. Requirements for target-controlled infusion of propofol to insert the laryngeal mask airway. Anaesthesia 1998; 53: 222–226.Google Scholar
Ovassapian A. Fiberoptic assisted airway management. Acta Anaesthesiol Scand 1997; 110: 46–47.Google Scholar
Schaefer HG, Marsch SC. Comparison of orthodox with fibreoptic orotracheal intubation under total i.v. anaesthesia. Br J Anaesth 1991; 66: 608–610.Google Scholar
Schaefer HG, Marsch SC, Strebel SP, Drewe J. Cardiovascular effects of fibreoptic oral intubation. A comparison of a total intravenous and a balanced volatile technique. Anaesthesia 1992; 47: 1034–1036.Google Scholar
Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg 1992; 75: 788–793.Google Scholar
Stevens JB, Vescovo MV, Harris KC, Walker SC, Hickey R. Tracheal intubation using alfentanil and no muscle relaxant: is the choice of hypnotic important? Anesth Analg 1997; 84: 1222–1226.Google Scholar
Georgi R. Fiber optic intubation. Indications and procedure. Anasthesiol Intensivmed Notfallmed Schmerzther 1995; 30: 172–174.Google Scholar
Kleemann PP. Fiberoptic endoscopic intubation: training with the technique. Anasthesiol Intensivmed Notfallmed Schmerzther 1995; 30: 141–145.Google Scholar
Lipp M, Daublaender M, Ellmauer ST, von DH, Stauber A, Dick W. Changes in temporomandibular joint functions in various general anesthesia procedures. Anaesthesist 1988; 37: 366–373.Google Scholar