Remifentanil/propofol for fiberoptic intubation. A case report

We report a case of a 41-years-old woman presenting for revision of a secon dary reconstructive procedure using the modified Tagliacozzi upper arm flap after subtotal maxillectomy. Because of the pedicle flap the upper arm was fixed in a pre-facial position and so fiberoptic intubation was required. After routine pre-anesthetic preparations and topical anesthesia of the nar es and nasopharynx a CO2 measuring catheter as well as a O-2 catheter to ad minister 100% oxygen was inserted deeply into the left naris. At that time, a continous infusion of 0,05 mu g/kg/min remifentanil and 2 mg/kg/h propof ol was started. After 4 min, fiberoptic intubation was performed through th e right nare without any technical difficulties in conscious sedation of th e patient. Du ring the entire fiberoptic intubation SaO(2) was constant at 100% and capnogram tracings with etCO(2) values ranging from 31 to 33 mmHg were displayed on the monitor. At the end of this second surgical procedure with fixed pre-facial upper arm position the patient was uneventfully extu bated fully awake. For the time period of fiberoptic intubation the patient had complete amnesia. Conclusion. With the use of nasal capnography and ca pnometry in addition to simultaneous O-2 administration during fiberoptic i ntubation under extreme conditions excellent analgosedation with propofol a nd remifentanil could be provided without compromizing our patients' safety . The presented CO2 measuring and O-2 administering device represents a sim ple and cheap expansion of standard anesthetic monitoring during fiberoptic intubation.