Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh.

BACKGROUND AND OBJECTIVE: The combination remifentanil-propofol was used for tracheal intubation without muscle relaxant in patients with anticipated difficult airway. Using a target-controlled infusion, we compared the remifentanil concentrations required for intubation with the Macintosh laryngoscope and the Glidescope, at a constant plasma concentration of propofol without muscle relaxant. METHODS: Sixty ASA I or II patients were randomly assigned to either the Macintosh or Glidescope group (30 per group). A target-controlled infusion of propofol was used to maintain a predetermined effect-site concentration of 3 microg ml. The target concentration of remifentanil for each patient in a group was determined by the response of the previous patient, using increments or decrements of 0.5 ng ml. Intubation was attempted at 4 min following induction to allow for equilibration between the blood and the effect site. The intubation response was graded as successful or failure by the Helbo-Hansen scoring system. The median effective concentration of remifentanil for tracheal intubation was determined using the probit regression model. RESULTS: The median effective concentration of remifentanil required for intubation with the Macintosh laryngoscope was 4.41 ng ml (3.13-5.27; 95% confidence interval) and that of the Glidescope was 5.45 ng ml (4.45-6.45; 95% confidence interval; P = 0.083). There was no difference in the total intubation scores. No patients showed signs of muscle rigidity. Arterial pressures or heart rate did not differ between the groups. CONCLUSION: There is no strong evidence that the target remifentanil concentrations required for adequate intubating conditions differed according to the technique used for intubation in the nonparalysed patient. We did not detect any major complications using this technique for either method.

Laryngeal sarcoidosis: treatment with the antileprosy drug clofazimine.

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.

Leprosy of the larynx: a clinicopathological study.

Ten established cases of lepromatous leprosy with laryngeal involvement are reported, and their clinical and histopathological findings are discussed with a brief review of the literature.