A 35-year-old female with a known difficult airway (previous radiation to the neck) is scheduled for elective hemithyroidectomy. Awake tracheal intubation is planned. Which drug is MOST appropriate for sedation during awake fibreoptic intubation to maintain spontaneous ventilation and patient cooperation?
- A Remifentanil infusion at 0.05 to 0.1 mcg/kg/min with low-dose midazolam ✓
- B Propofol bolus followed by infusion at 100 mg/kg/min
- C Ketamine 1 mg/kg IV bolus as a single dose
- D Sevoflurane 8% inhaled via face mask
Correct answer: A. Remifentanil infusion at 0.05 to 0.1 mcg/kg/min with low-dose midazolam
Explanation
Remifentanil provides excellent sedation and analgesia with rapid onset and offset, preserving spontaneous ventilation and airway reflexes enough to tolerate the procedure while keeping the patient cooperative. It is the agent of choice for awake intubation sedation in current practice. Propofol in high doses abolishes ventilation. Sevoflurane via mask is impractical for airway topicalisation. Ketamine can cause excessive secretions and emergence reactions.
Reference: Miller's Anesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.