title: [Propofol sedation allows awake intubation of the difficult airway with the Fastrach LMA].
abstract: OBJECTIVE
  To evaluate target controlled infusion anesthesia (TCI) with propofol for conscious intubation [(Ramsay score equal to 3 (RS 3)] through the Fastrach laryngeal mask airway (LMA).
  
  
  METHODS
  17 consenting and unpremedicated patients, who showed criteria for difficult intubation (score developed by Arne et al. > or = 11), were monitored and received supplemental oxygen. Propofol was administered by TCI, with successive targets of 0.6 and 1 microg x mL(-1), while the RS was evaluated: if = 3, LMA intubation was attempted, if < 3 the TCI was increased by steps of 0.2 microg x mL(-1) until an RS of 3 was reached. Local anesthesia (lidocaine 5%) of the oropharynx was carried out at 0.6 and 1 microg x mL(-1), together with local anesthesia of the nasopharynx at 1 microg x mL(-1). A standardized questionnaire evaluated memory of and satisfaction with the technique (score/10) on postoperative day 1.
  
  
  RESULTS
  The LMA was inserted in 100% of cases and intubation was successful in 16 out of 17 cases (one failure). The propofol target concentration to obtain a RS of 3 was 1.25 +/- 0.07 microg x mL(-1). Amnesia occurred as soon as the target concentration of propofol exceeded 1 microg x mL(-1). The patients found the technique very satisfactory (median satisfaction score = 9.4/10). Incidents of coughing or nausea were observed in 47% and 5% of cases respectively. There was no oesophageal intubation and no desaturation (SpO2 < 95%).
  
  
  CONCLUSIONS
  Propofol administered by TCI to achieve a RS of 3 allows conscious intubation to be performed through a LMA under satisfactory conditions. A LMA could be a possible alternative to a "conscious" fibroscopy.
authors.affiliation: Du Groupement d'Anesthésie et de Réanimation Chirurgical, Service d'anesthésie réanimation chirurgicale, Centre hospitalier universitaire de Tours, 2 boulevard Tonnelé, 37000 Tours, France. hamardf@voila.fr
authors.forename: Franck
authors.initials: F
authors.lastname: Hamard
authors.forename: Martine
authors.initials: M
authors.lastname: Ferrandiere
authors.forename: Xavier
authors.initials: X
authors.lastname: Sauvagnac
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Mangin
authors.forename: Jacques
authors.initials: J
authors.lastname: Fusciardi
authors.forename: Colette
authors.initials: C
authors.lastname: Mercier
authors.forename: Marc
authors.initials: M
authors.lastname: Laffon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D014851:Wakefulness
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol