title: Pressure support ventilation during fibreoptic intubation under propofol anaesthesia.
abstract: OBJECTIVE
  To assess the benefit of pressure support ventilation during fibreoptic intubation performed under propofol anaesthesia in patients having an anticipated difficult intubation.
  
  
  METHODS
  Thirty-two patients with ENT cancer, and having at least two criteria for anticipated difficult intubation were prospectively included. All patients received topical lidocaine 2% and propofol by plasma target control infusion (initial target concentration 3 microg ml(-1), then adjusted to maintain loss of consciousness without apnoea). They were randomly assigned between two groups: spontaneous breathing (SB) or pressure support ventilation (with a support level set at 10 cm H(2)O) both using Fi(o(2))=1. Conditions for fibreoptic intubation, respiratory parameters (pulse oxymetry, ventilatory frequency, tidal volume and PetCO2 after intubation) and haemodynamic parameters were recorded.
  
  
  RESULTS
  Patient characteristic data and intubation conditions were similar between both groups. All patients had a successful fibreoptic intubation and none needed a rescue procedure because of desaturation. In spite of a longer duration of intubation, PE'CO2 after intubation was lower and tidal volume during intubation was higher with pressure support ventilation than in SB patients [38.1 (4.2) vs 42.3 (4.7) mm Hg and 371 (139) vs 165 (98) ml, respectively]. Desaturation episodes were observed in two SB patients conversely to no episode during pressure support ventilation, probably because of the higher minute ventilation.
  
  
  CONCLUSIONS
  Pressure support represents a useful method to improve ventilation during fibreoptic intubation under propofol anaesthesia in patients with an anticipated difficult intubation.
authors.affiliation: Service d'Anesthésie, Institut Gustave Roussy, 39 rue C Desmoulins, 94805 Villejuif, France. bourgain@igr.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Bourgain
authors.forename: V
authors.initials: V
authors.lastname: Billard
authors.forename: A M
authors.initials: AM
authors.lastname: Cros
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous; D002245:Carbon Dioxide / Q000502:physiology; D005336:Fiber Optic Technology; D006258:Head and Neck Neoplasms / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015742:Propofol; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D013990:Tidal Volume
chemical_list: D018686:Anesthetics, Intravenous; D002245:Carbon Dioxide; D010100:Oxygen; D015742:Propofol