Abstract:

Objective  To investigate if midazolam combined with remifentanil could  provide a good condition for tracheal incision and intubation with less intubation responses and awareness .  Methods   30 ASA Ⅰ or Ⅱ laryngocarcinoma patients aged 35-55 yrs were randomly divided into 2 groups ( n = 30 each) according to the types of anesthesia for tracheal incision and intubation: patients of group I received innovar 2mL before tracheal incision, while those of group R received midazolam 50μg·Kg－1 followed by a constant infusion of remifentanil（0.05 μg·Kg－1·min－1 ）. Tracheal incision was achieved under local infiltration anesthesia. Just before tracheal intubation, all patients assigned to group I received innovar 2mL, while patients assigned to group R received remifentanil 1μg·Kg－1.   MAP, HR and SpO2 were monitored and recorded before local infiltration anesthesia (T0),  before tracheal intubation (T1), at the moment of tracheal intubation success  (T2), and two minutes after anesthesia induction (T3). Propofol used for anesthesia induction  was recorded as well. Responses such as restlessness and coughing were also recorded . The patients′ awareness of tracheal incision and intubation was recorded after operation . Results   As compared with the baseline values at T0, MAP and HR were significantly increased at T2 （P＜0.05）, while MAP and HR at T3 were significantly decreased  in group I（P＜0.05）； In group R, HR at T3 were significantly decreased（P＜0.05）. As compared with group I, HR and  MAP at T2 in group R were significantly decreased（P＜0.05）, while MAP at T3 were significantly increased（P＜0.05）. Propofol used for anesthesia induction was much higher in group I than that in group R（P＜0.01）. The incidences of tracheal intubation responses such as coughing and restless were significantly higher in group I than that in group R（P＜0.01）. The incidence of awareness was significantly lower in group R than that in group I（P＜0.01） . Conclusion   Midazolam combined with remifentanil can provide a good condition for tracheal incision and intubation with less intubation responses and awareness .

Key words: Piperidines; Midazolam; Intubation, tracheal; Conscious sedation