Applications Of Monitored Anesthesia Care With Remifentanil And Propofol For Coblation Assisted Upper-airway Procedure

ObjectiveTo explore the effective and safe method of monitored anesthesia care for coblation assisted upper-airway procedure(CAUP).MethodsEighty ASA classⅠorⅡpatients scheduled for CAUP were randomly divided into 4 groups(n=20 each)receiving respectively a continuous infusion of saline(group S), 25μg·kg^-1.min^-1of propofol(group P),0.05μg.kg^-1.min^-1of remifentanil(group R),propofol plus remifentanil of the same infusionrate(group PR).Infiltration of local anesthetics and surgery started 10 min later.The pain during injection and surgery was assessed with the world health organization pain scale.Grade 0 for no pain and relaxed,gradeⅢfor severe pain and suffering.Patients with Severe Pain were treated with a bolus of corresponding propofol 10mg or remifentanil 20μg and with increasing infusion rate. The MAC to the patient was defined as failed if the pain was still severe when Ramsay scale＞3 or respiratory depression appeared.Rescue medication may then be provided.ResultsPain scale during the injection of local anesthetics and surgery was more higher in group S and P comparing with that in group R and PR(P＜0.01).More patients in group S and P needed rescue medication comparing to that in group R and PR(P＜0.01).No prolonged respiratory depression occurred.3 patients encountered airway partially occlusion and snored during the surgery,but were successfully released by insertion of oral airway.All patients recovered promptly at the end of the procedure and no respiratory event occurs during recovery. ConclusionMonitored anesthesia care with continuous infusion of remifentanil significantly released the affliction pain of patients during CAUP.Careful monitoring and management is essential to ensure patient safety.Propofol,however,was not as effective when infused alone or adjunct to remifentanil.