TCI remifentanil vs. TCI propofol for awake fiber-optic intubation with limited topical anesthesia

The purpose of this study was to compare the effects of propofol and remifentanil target-controlled infusion (TCI) on awake fiber-optic intubation with limited local anesthesia. 36 patients requiring fiberoptic intubation were randomized to receive propofol (P) or remifentanil (R) effect-site TCI. Target concentrations, sedation levels, pulse oximetry, hemodynamic change, duration, number of adjustments, intubating conditions and recall after surgery were recorded at each stage. The results showed that the target intubation concentration of remifentanil was very close to the sedation concentration but that the intubation concentration of propofol was more than double its sedation concentration (5.83±1.46 μg/ml vs. 2.60±0.47 μg/ml, respectively). Vocal cord opening was significantly better in remifentanil-treated patients. More adjustments and a longer duration were required in propofol-treated patients. Recall was significantly more frequent in remifentanil-treated patients. We concluded that compared to TCI propofol, TCI remifentanil can provide safer and better intubating conditions for fiber-optic intubation with limited local anesthesia.