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BJA Advance Access originally published online on November 23, 2007
British Journal of Anaesthesia 2008 100(1):125-130; doi:10.1093/bja/aem279
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded randomized controlled trial

M. R. Rai1, T. M. Parry1, A. Dombrovskis2 and O. J. Warner1,*

1 Nuffield Department of Anaesthetics, Oxford Radcliffe NHS Trust, Headley Way, Headington, Oxford OX3 9DU, UK
2 Epsom General Hospital, Dorking Road, Epsom, Surrey KT18 7EG, UK

* Corresponding author. E-mail: orlandowarner{at}regatta.plus.com

Background: Awake fibreoptic intubation (AFOI) is a technique used in patients with difficult airways. This study compares the suitability of remifentanil target-controlled infusion (TCI) to propofol TCI for conscious sedation during AFOI in patients with bona fide difficult airways.

Methods: We recruited 24, ASA I–III patients, who were undergoing sedation for elective AFOI. Patients were randomized to one of the two groups, Group P (n=10) received propofol TCI and Group R (n=14) received remifentanil TCI. Primary outcome measures were conditions achieved at endoscopy, intubation, and post-intubation, which were graded using scoring systems. Other parameters measured were the endoscopy time, intubation time, and number of attempts at intubation. A postoperative interview was conducted to determine recall of events and level of patient satisfaction.

Results: Endoscopy scores (0–5) and intubation scores (0–5) were significantly different [Group P 3 (1–4) vs Group R 1 (0–3) P<0.0001, Group P 3 (2–4) vs Group R 1 (0–3) P<0.0001, respectively]; with much better conditions in Group R, endoscopy times and intubation times were also significantly different, being shorter in Group R (P<0.007 and P<0.023, respectively). Patient tolerance of the procedure, judged by the discomfort scores (P<0.004) and the post-intubation scores (P<0.08), was significantly better in Group R. The level of recall for events was higher in Group R. However, there were no significant differences in the patient satisfaction scores.

Conclusions: Remifentanil TCI appears to provide better conditions for AFOI when compared with propofol TCI. The disadvantage of remifentanil in this setting may be a higher incidence of recall.

Keywords: anaesthetic techniques, fibreoptic; anaesthetics i.v., propofol; analgesics opioid, remifentanil; sedation


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Opioid or Propofol: What Kind of Drug for What Kind of Sedation? Manual Dosing or Target-Controlled Infusion?
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Remifentanil vs propofol for awake fibreoptic Intubation
Sally J Hargreaves, et al.
British Journal of Anaesthesia, 22 Jan 2008 [Full text]
Increasing acceptance of Remifentanil for Sedation in Awake Fibreoptic Intubation
Glyn D Harrison, et al.
British Journal of Anaesthesia, 12 Feb 2008 [Full text]
Remifentanil vs Propofol for awake fibreoptic intubation
Mario Shekar
British Journal of Anaesthesia, 29 Feb 2008 [Full text]

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