[Fiberoptic intubation in adult patients with predictive signs of difficult intubation: inhalational induction using sevoflurane and an endoscopic facial mask].
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.


METHODS
Prospective study.


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).


CONCLUSIONS
Inhalational induction with sevoflurane and fiberoptic intubation appeared easy, fast and cheap.
Favier
J C
JC
Service de réanimation polyvalente, département d'anesthésie-réanimation-urgences, HIA Legouest, BP10, 57998, Metz-Armée, France. legouest.daru@dial.oleane.com <legouest.daru@dial.oleane.com>
Da Conceiçao
M
M
Genco
G
G
Bidallier
I
I
Fassassi
M
M
Steiner
T
T
Pitti
R
R
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation / Q000191:economics; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000502:physiology; D001999:Bronchoscopy; D005260:Female; D005336:Fiber Optic Technology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000191:economics / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011292:Premedication; D011446:Prospective Studies; D000077149:Sevoflurane; D017409:Sufentanil
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D017409:Sufentanil
Intubation fibroscopique sous sévoflurane chez l'adulte avec un masque facial endoscopique en cas d'intubation difficile.