Kết quả chuẩn độ propofol TCI để đạt an thần tỉnh trước đặt nội khí quản khó ở người bệnh áp xe vùng hàm mặt

Abstract

Conscious sedation helps reduce anxiety and improve patient cooperation during awake fiberoptic intubation in patients with anticipated difficult airways. However, the margin between conscious sedation and deep sedation is narrow, with a high risk of respiratory depression. This study aimed to evaluate the results of titrating the effect-site target concentration of propofol using target-controlled infusion (TCI) with the Schnider model to achieve the desired level of conscious sedation before flexible endoscopic intubation in patients with maxillofacial abscess and trismus. This was a prospective, single-arm interventional study including 51 patients with trismus, defined as a maximum mouth opening of < 20 mm. Conscious sedation was performed using propofol target-controlled infusion (propofol TCI) based on the Schnider pharmacokinetic model. Propofol TCI was initiated at an effect-site concentration (Ce) of 0.8 µg/mL and adjusted by increasing 0.2 µg/mL or decreasing 0.1 µg/mL every 2 minutes until until the desired level of conscious sedation was achieved, defined as an OAA/S score of 4 and a BIS value of 80 - 90. The desired level of sedation was achieved with a median BIS of 84 (82 - 85) and a median Ce of 0.8 (0.8 - 1.0) µg/mL. One case of transient apnea occurred at a target Ce of 1.0 µg/mL. Conclusion: Propofol TCI at an effect-site concentration of 0.8 - 1.0 µg/mL can help patients achieve the desired level of conscious sedation, defined as an OAA/S score of 4 and a BIS value of 80 - 90, before flexible endoscopic intubation in patients with maxillofacial abscess and trismus. However, it should be titrated in small stepwise increments, with close respiratory monitoring and a prepared emergency airway management plan.