The purpose of this prospective study was to evaluate the patient response and the changes of blood pressure and heart rate following intravenous administration of various dosage of fentanyl during awake fiberoptic nasotracheal intubation.
After verbal informed consent, the 44 ASA status I or II patients undergoing oral and maxillofacial surgery were randomly assigned to receive 0(N=11), 1(N=11), 2(N=11), 3(N=11) μg/kg of fentanyl. On arrival to operating room, midazolam 2 mg and
glycopyrrolate 0.2 mg were administered for premedication. And then, EKG, blood pressure and peripheral O2 saturation were monitored continuously. Local anesthesia was induced with the gargling of 4% lidocaine 10ml, the transtracheal injection of
4%
lidocaine 3ml and nasal spray 10% lidocaine 0.5ml. After that each dose of fentanyl was given to each groups. And then fiberoptic intubation was performed with continuous verbal contact to confirm the patient response and ventilatory status
during
intubation. During fiberoptic intubation, the peak level of blood pressure and heart rate were recorded. We compare the difference of blood pressure and heart rate between the value of just before fiberoptic intubation and the peak value during
fiberoptic intubation and discomfort score according to fentanyl dosage on the first day of postoperation.
The change of blood pressure and the time required for intubation was less and shortest in the 2 μg/kg of fentanyl group. But there were no significant differences in heart rate and discomfort score.
We conclude that 2 μg/kg of fentanyl minimize the change of blood pressure as well as intubation time. But the change of dosage of fentanyl was not helpful to decrease the discomfort score. (Korean J Anesthesiol 1995; 29: 358~363)
|