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Sleep and Breathing

, Volume 22, Issue 4, pp 919–923 | Cite as

Effect of remifentanil during drug-induced sleep endoscopy in patients with obstructive sleep apnea

  • Youngsoon Kim
  • Hyungjun Park
  • Junoik Shin
  • Jeong-Hyun Choi
  • Sung Wook Park
  • Hee Yong KangEmail author
ENT • Original Article

Abstract

Purpose

During drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea, the increased depth of propofol anesthesia is related to the increased collapsibility of the upper airway with dose-dependent. We examined the effect of remifentanil on propofol concentration during DISE.

Methods

In a prospective randomized trial, 56 adult patients were divided into remifentanil-propofol (n = 28) and propofol alone (n = 28) groups. Anesthesia was administered using a target-controlled infusion system. In the remifentanil-propofol group, 0.5 ng/ml remifentanil was administered prior to propofol infusion and its concentration maintained; thereafter, in the propofol alone group, normal saline was injected instead of remifentanil. Propofol was infused at a concentration of 1.5 μg/ml after the target concentration of remifentanil was reached. In both groups, the concentration of propofol was increased by 0.5 μg/ml if the degree of sedation was not sufficient. The sedation level was targeted at observer’s assessment of alertness/sedation (OAA/S) scale 3.

Results

The mean propofol concentration was 2.87 ± 0.60 μg/ml in the remifentanil-propofol group, which was lower than that in the propofol alone group (3.38 ± 0.72 μg/ml, P < 0.001). The time until sufficient sedation to perform DISE was shorter in the remifentanil-propofol group (P < 0.001). Apnea-hypopnea index and the lowest peripheral capillary oxygen saturation (SpO2) during polysomnography showed no statistical difference between groups (P > 0.05). The lowest SpO2 and VOTE classification during DISE were also not statistically different (P > 0.05).

Conclusions

Use of remifentanil during DISE reduces the target concentration of propofol required for patient sedation to perform DISE without respiratory depression.

Keywords

Drug-induced sleep endoscopy Obstructive sleep apnea Propofol Remifentanil 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11325_2018_1738_MOESM1_ESM.docx (12 kb)
Supplemental data 1 (DOCX 12 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineKyung Hee University HospitalSeoulSouth Korea

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