Evaluación de la eficacia y seguridad de un protocolo de intubación mediante fibroscopio en paciente despierto. Estudio descriptivo retrospectivo

Abstract

Background and objectiveFlexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital’s awake fiberoptic intubation protocol. Material and methodsFor retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol’s key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients’ diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. ResultsIn the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. ConclusionOur hospital’s protocol was followed in all cases and no post-implementation complications were detected.