Abstract
Purpose
To report the use of propofol and remifentanil infusions to facilitate smooth extubation of a surgically resected airway.
Clinical features
A 19-yr-old man weighing 85 kg was scheduled for tracheal resection surgery following postintubation tracheal stenosis. He had a relatively long segment (4 cm) of his trachea resected and anastomosed. Postoperatively, he was sedated and electively ventilated for four days in a chin to chest position by stay sutures. In order to reduce any risk of traumatic disruption to the tracheal anastomosis, we planned to extubate his trachea under light general anesthesia. Attempts to extubate his trachea using propofol and alfentanil infusions failed. We used propofol and remifentanil infusions to achieve a state of sedate cooperation and extubated his trachea with fibreoptic bronchoscope guidance.
Conclusion
Propofol and remifentanil infusions in combination can facilitate successful extubation of the surgically resected airway with high risk of disruption.
Résumé
Objectif
Présenter ľusage de perfusions de propofol et de rémifentanil pour faciliter ľextubation en douceur de voies aériennes réséquées chirurgicalement.
Éléments cliniques
Un jeune homme de 19 ans, de 85 kg, devait subir une résection trachéale à la suite ďune sténose trachéale post-intubation. Un segment relativement long (4 cm) de sa trachée a été réséqué et anastomosé. Après ľopération, il a reçu une sédation et une ventilation réglée pendant quatre jours, tête maintenue penchée vers le thorax par des sutures de fixation. Pour réduire le risque de rupture traumatique de ľanastomose trachéale, ľextubation a été réalisée sous anesthésie générale. Les tentatives ďextubation, utilisant des perfusions de propofol et ľalfentanil, ont échoué. Des perfusions de propofol et de rémifentanil ont été utilisées pour atteindre un état de calme et de coopération et permettre ľextubation de la trachée avec un fibroscope bronchique comme guide.
Conclusion
Les perfusions combinées de propofol et de rémifentanil peuvent faciliter le succès de ľextubation de voies aériennes réséquées chirurgicalement et à haut risque de rupture.
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Saravanan, P., Marnane, C. & Morris, E.A.J. Extubation of the surgically resected airway — a role for remifentanil and propofol infusions. Can J Anesth 53, 507–511 (2006). https://doi.org/10.1007/BF03022625
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DOI: https://doi.org/10.1007/BF03022625