2018 Volume 46 Issue 2 Pages 71-73
Respiratory depression frequently occurs during fiberoptic intubation in patients sedated with benzodiazepines, propofol and opioids. Dexmedetomidine has been used for sedation during fiberoptic intubation because it has a small respiratory depression effect. However, the effectiveness of DEX for fiberoptic nasal intubation remains unclear. We report 4 cases in which dexmedetomidine and fentanyl were used for sedation during fiberoptic nasal intubation.
In Case 1, a total of 1.1 μg/kg of DEX was administered during intubation, but increases in pulse and blood pressure were observed. The DEX plasma concentration was 1.17 ng/ml after the completion of intubation.
In Case 2, a total of 1.2 μg/kg of DEX and 0.9 μg/kg of fentanyl were administered during intubation, but a coughing reflex occurred. After the end of intubation, the DEX serum concentration was 0.84 ng/ml, the fentanyl plasma concentration was 0.54 ng/ml, and the effect-site concentration was 0.91 ng/ml.
In Case 3, a total of 1.0 μg/kg of DEX and 2.3 μg/kg of fentanyl were administered during intubation. After the end of intubation, the DEX serum concentration was 0.91 ng/ml, the fentanyl plasma concentration was 1.39 ng/ml, and the effect-site concentration was 2.19 ng/ml.
In Case 4, a total of 1.0 μg/kg of DEX and 2.0 μg/kg of fentanyl were administered during intubation. After the end of intubation, the DEX plasma concentration was 1.07 ng/ml, the fentanyl plasma concentration was 1.17 ng/ml, and the effect-site concentration was 1.84 ng/ml.
Our findings suggest that when a DEX plasma concentration of 1.0 ng/ml is used for sedation during fiberoptic nasal intubation, the use of 2.0 μg/kg of fentanyl is effective.
