Abstract PR540

Abstract

Background & Objectives: Awake fibreoptic intubation requires adequate sedation for the procedure without inducing the patient’s apnea. The aim of our study was to compare two ways of sedation for tracheal intubation under fibreoptic (ITF). Materials & Methods: A prospective study including 40 adult patients admitted for scheduled reconstructive surgery of the face burns requiring ITF. They were randomized into 2 groups: - GR: under sedation remifentanil - GD: dexmedetomidine sedation All patients underwent a gargle by the lidocaïne 5%, and then practice a bilateral laryngeal nerve block according to the technique of Vannier. Then three lidocaïne sprays are made at each nostril. Finally, the endoscope is lubricated by the lidocaïne gel. Oxygenation was maintained through a nasal tube (6l / min). Then, patients GR received sedation with a remifentanil bolus 0.75 µgkg-1 followed by an infusion at a rate of 0.075 µgkg-1 min-1. In GD, intravenous sedation with a dexmedetomidine bolus of 0.4 µgkg-1 followed by an infusion at a rate of 0.7 µgkg-1 hr-1. Then we proceeds to ITF. Statistical analyze is ensured by SPSS 22 (p < 0.05). Results: no difference between the 2 groups for age (GR: 44.7 ± 11,9years vs GD: 41.6 ± 15.3; p = 0.39) and BMI (kg / m2): 23.9 ± 1,3 in GRvs24,8 ±1,7dans GD, p = 0.33. The ease of intubation (0to10): 4.3 /10 in GR vs 3.4/10 in GD, p = 0.11. Successful ITF from the 1st attempt: 75% (GR) vs85% (GD); p = 0, 21.Sedation depth (RAMSAY>3): 5% (GR) vs 0% (GD); p = 0.09; bronchospasm: 30% GR vs 10% GD(p = 0,11. respiratory distress (bradypnea, SpO2 < 90%): 10% GR vs. 5% GD(p = 0, 22. cough: 20% GR vs 15% GD p = 0.45. Conclusion: dexmedetomidine or Remifentanil associated to local anesthesia; allow ITF in good conditions