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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
CLINICAL CASES CRITICAL CARE
Minerva Anestesiologica 2002 November;68(11):867-71
Tracheal intubation in a case of idiopathic pulmonary fibrosis using remifentanil and propofol without muscle relaxants
Cafiero T., Burrelli R., Gargiulo G., Mastronardi P.
Dipartimento di Scienze Chirurgiche, Anestesiologiche, Rianimatorie e dell’Emergenza, Università degli Studi «Federico II», Napoli
The anesthetic management of a 58 year-old-male suffering from idiopathic pulmonary fibrosis associated with a previous experience of altered dose-response relationship to muscle relaxants is reported. He underwent a gastroendoscopic surgical procedure. After intravenous atropine, remifentanil 3.0 µg kg-1 was injected over 90 sec. Sixty seconds after the start of remifentanil bolus dose, propofol 2.0 mg kg-1 was injected and intubation was performed 1 min after the administration of propofol. Anesthesia was maintained by N2O, oxygen, sevoflurane (0.5-0.8%) and remifentanil titrated infusion (mean dose of 0.15 mg kg-1 min-1) under spontaneous respiration or assisted ventilation, if the patient was apnoic. The intubating conditions were good, a 30 per cent reduction in MAP was observed after propofol administration. The patient regained consciousness 5 minutes after the end of remifentanil administration and his trachea was extubated without any troubles. Recovery was uneventful without the need of long-term intensive therapy.