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Extubation of the surgically resected airway - a role for remifentanil and propofol infusions

[Extubation de voies aériennes réséquées chirurgicalement - un rôle pour les perfusions de rémifentanil et de propofol]

Palanikumar Saravanan, FRCA^*, Conor Marnane, FRCS ORL-HNS and Edmund A.J. Morris, FRCA

^* From the Department of Anesthetics, Bristol Royal Infirmary, and the
Department of ENT, Southmead Hospital, Bristol, United Kingdom.

Address correspondence to: Dr. Edmund A.J. Morris, Department of Anesthetics, Southmead Hospital, Bristol, United Kingdom - BS10 5NB. Phone: +44 117 9595114; Fax: +44 117 9595075; E-mail: edmund.morris{at}nbt.nhs.uk

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.