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  • Title: [Fiberoptic intubation in adult patients with predictive signs of difficult intubation: inhalational induction using sevoflurane and an endoscopic facial mask].
    Author: Favier JC, Da Conceiçao M, Genco G, Bidallier I, Fassassi M, Steiner T, Pitti R.
    Journal: Ann Fr Anesth Reanim; 2003 Feb; 22(2):96-102. PubMed ID: 12706762.
    Abstract:
    OBJECTIVE: To evaluate the combination of inhalational induction with sevoflurane and fiberoptic intubation through a specific facial mask for anticipated difficult tracheal intubation (DI) in adults. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Eighteen consecutive patients at risk of DI. After premedication made of hydroxyzine 2 mg x kg(-1), preoxygenation, 0.1 microg x kg(-1) sufentanil was administered (T0), then, inhalational induction was started: sevoflurane 8% in 100% O2 l x min(-1). After 1 min, sevoflurane was decreased to 5% and, if necessary, adapted to obtain an adequate depth of anaesthesia (Ramsay score > 3). Fiberoptic bronchoscopy was performed through a Fibroxy mask. BP was measured every 2.5 min, HR, SpO2, RR were recorded. The results were analyzed by Newman-Keuls test. RESULTS: Intubation was easily realized but it was necessary to assist ventilation in patients presenting prolonged apnea lasting more than 30 s (5 out of 9 patients who presented apnea during procedure). Intubation was quickly realized (T+ 4 +/- 3 min). Haemodynamics and saturation were not altered during procedure. Inhalatory induction using sevoflurane costs 6 10 versus 16 80 for intravenous target controlled propofol anesthesia (using only one preconditionned syringe). CONCLUSION: Inhalational induction with sevoflurane and fiberoptic intubation appeared easy, fast and cheap.
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