Effects Of Sufentanil On Stress And Cardiovascularresponse During Awake Nasotracheal FOB Intubation

Objective: Difficult airways is a challenge for the anesthesiologist. Fibreoptic bronchoscope (FOB) intubation is an effective technique for the management of patients with difficult airways. But there are also many disadvantage stress responses by this way. The aim of this prospective, randomized double-blind study is to explore the optimal dose of Sufentanil complexed with midazolam for awake nasotracheal fibreoptic intubation and to provide an effective basis for clinical application.Methods: Sixty patients ASAâ… ^â…¡, aged 18 to 60 years old scheduled for awake nasotracheal fiberoptic intubation were randomized into 4 groups sufentanil target plasma concentration(Cp):0.3ng/ml, 0.5ng/ml, 0.8ng/ml in groupâ… ,â…¡andâ…¢(n=15). Fifteen patients in group A just received saline as compared. All patients were inducted with midazolam 0.02 mg/kg IV. 2% lidocaine were used for nasal and pharyngeal surface anesthesia and 1% Tetracaine used to cricothyroid membrane puncture. When the target controlled Cp of sufentanil had got our set, stop infusion and begain the fiberoptic intubation. The experimental datas were collected at different time points as follows: Five minutes after arrival, baseline values were recoded at T0, after sufentanil administration as T₁, intubation as T₂, one minute after intubation as T₃, three minutes after intubation as T₄, five minutes after intubation as T₅; HR,SBP,DBP,MAP,RPP(Real Portfolio Project), TP (Tip Perfusion Index) were recorded at each time point; Blood samples were taken to determine the epinephrine(E), norepinephrine(NE), cortisol(Cor), SaO2 and PaCO₂ respectively at T₀,T₁,T₃,T₄. And the adverse reactions throughout the process were recorded.Results:1 Three cases were excluded because of unprosperous during FOB. Fifity-seven cases were involved in this study.2 There were no difference in four groups concerning demographic (P> 0.05).3 All the baseline values had no difference in four groups(P> 0.05).4 Compared with baseline values HR, SBP, DBP, MBP, RPP in group A andâ… at time T₂ and T₃ were significantly increased (P <0.05), while in groupâ…¡andâ…¢they were no significant difference (P> 0.05).5 TPI: At T1 TPI were obviously increased than baseline values in four groups respectively(27%, 33%, 36%, 46%). TPI in groupâ…¡andâ…¢had slightly changed during this intubation.6 NE, E, Cor: At T₁ NE, E, Cor in four groups had decreased compared with baseline values especially in groupâ…¡andâ…¢. NE ,Cor in group A andâ… at T₃ were significantly increased than T₀ (P <0.05),while E at T4 were significantly increased. NE, E, Cor in groupâ…¡andâ…¢at T₃ T₄ were no significant differences compared with T0 (P> 0.05) .7 The incidences of stress response among four groups were significant different which in groupâ…¡andâ…¢were significant decreased than group A andâ… (respectively 67%, 53%, 13%, 7%, P <0.05).8 SaO₂: In groupâ…¡a ndâ…¢at T₁ SaO2was more decreased than T0 ,especially in groupâ…¢the SaO2 was still decreased than T0 at T₃ T₄ (P> 0.05).9 PaCO₂: In groupâ…¡andâ…¢at T1 PaCO₂ was more increased than T0, especially in groupâ…¢the PaCO₂ was still increased than T₀ at T3 T4 (P> 0.05).10 Adverse reactions: Two cases with cough and tow cases with arrhythmia (sinus tachycardia)were present in group A. Two cases with cough in groupâ… ; One case with arrhythmia in groupâ…¡;Two cases severe respiratory depressions, one case vomiting, and one case sinusbradycardia in groupâ…¢.11 Ramsay scoles: There were 75% and 55% noncooperations in group A andâ… respectively. Patiens of 45% in groupâ…¢were hypersomnia. There were 75% cooperations in groupâ…¡.Conclution:1 Three dosages regimens plasma concentration sufentanil can produce a dose-related attenuation of the stress and cardiovascular response during awake nasotracheal FOB intubation.2 The small dosage regimen sufentanil (0.3 ng/ml)can not effectively attenuate the stress and cardiovascular response during awake nasotracheal FOB intubation.3 The large dosage regimen sufentanil (0.8 ng/ml)did not result in any additional benefit compared with the small dosage.4 For awake nasotracheal fiberoptic intubation, we therefore recommend sufentanil plasma concentration 0. 5ng/ml TCI supplemented with midazolam 0.02 mg/kg.