Intubation fibroscopique sous sévoflurane chez l'adulte avec un masque facial endoscopique en cas d'intubation difficile

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 kg –1, preoxygenation, 0.1 μg kg –1 sufentanil was administered (T0), then, inhalational induction was started: sevoflurane 8% in 100% O 2 l 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, SpO 2, 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.