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

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?P?2) 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.