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Fibre-optic intubation teaching in sedated patients with anticipated difficult intubation

Published online by Cambridge University Press:  01 March 2007

G. Gueret ,
V. Billard  and
J.-L. Bourgain
G. Gueret
Affiliation:
University Hospital, Anaesthesiology and Critical Care Department, Boulevard T Prigent, Brest, Villejuif Cedex, France
V. Billard
Affiliation:
Institut Gustave Roussy, Departement dAnesthésie, 39 rue Camille Desmoulins, Villejuif Cedex, France
J.-L. Bourgain
Affiliation:
Institut Gustave Roussy, Chef de Service dAnesthésie, Villejuif Cedex, France
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Summary

Background and objectives

The objective of the study was to assess the safety of training fibre-optic intubation performed under propofol light general anaesthesia in patients with an anticipated difficult intubation.

Methods

Patients with ear, nose and throat cancer having at least two criteria for anticipated difficult intubation and scheduled for fibre-optic intubation were included prospectively. In 26 patients, intubation was performed by an anaesthesia resident (under senior supervision), whereas in 20 patients, it was performed by a senior anaesthesiologist. All patients received propofol light general anaesthesia adjusted to maintain both loss of consciousness and spontaneous ventilation.

Results

Of the 46 patients, 45 had successful fibre-optic intubation, and one needed a rescue procedure because of hypoxaemia. Residents failed to intubate four patients, who were easily intubated by the senior. Episodic hypoxaemia (SPO2 < 90%) occurred in three patients in each group. No statistically significant difference was found between junior and senior neither on the duration of the procedure (9.3 ± 4.9 vs. 7.5 ± 4.0 min) nor on the propofol consumption (197 ± 130 vs. 193 ± 103 mg) or the ETCO2 at the end of the procedure (36 ± 6 vs. 38 ± 6 mmHg), respectively.

Conclusion

Teaching fibre-optic tracheal intubation in patients with anticipated difficult intubation and sedated with propofol did not increase morbidity significantly compared with an experienced anaesthesiologist. Fibre-optic intubation under propofol light general anaesthesia could be safely performed by a resident as long as a senior anaesthesiologist is permanently present, spontaneous ventilation is maintained and a rescue oxygenation technique is immediately available.

Keywords

INTUBATION INTRATRACHEAL, fibre-opticSEDATION CONSCIOUSEDUCATIONANAESTHESIOLOGYAIRWAY OBSTRUCTION
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 239 - 244
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Roberts, FL, Dixon, J, Lewis, GT, Tackley, RM, Prys-Roberts, C. Induction and maintenance of propofol anaesthesia. A manual infusion scheme. Anaesthesia 1988; 43 (Suppl): 14–17.CrossRefGoogle ScholarPubMed
2.Arne, J, Descoins, P, Fusciardi, J et al. . Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth 1998; 80: 140–146.Google Scholar
3.Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993; 78: 597–602.Google Scholar
4.Ovassapian, A, Yelich, SJ, Dykes, MH, Golman, ME. Learning fibreoptic intubation: use of simulators vs. traditional teaching. Br J Anaesth 1988; 61: 217–220.Google Scholar
5.Forbes, RB, Murray, DJ, Albanese, MA. Evaluation of an animal model for teaching fibreoptic tracheal intubation. Can J Anaesth 1989; 36: 141–144.CrossRefGoogle ScholarPubMed
6.Hartley, M, Morris, S, Vaughan, RS. Teaching fibreoptic intubation. Effect of alfentanil on the haemodynamic response. Anaesthesia 1994; 49: 335–337.Google Scholar
7.Cole, AF, Mallon, JS, Rolbin, SH, Ananthanarayan, C. Fiberoptic intubation using anesthetized, paralyzed, apneic patients. Results of a resident training program. Anesthesiology 1996; 84: 1101–1106.Google Scholar
8.Ovassapian, A, Dykes, MH, Golmon, ME. A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. Anaesthesia 1983; 38: 795–798.Google Scholar
9.Ovassapian, A, Tuncbilek, M, Weitzel, EK, Joshi, CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg 2005; 100: 585–589.Google Scholar
10.Garrett, WR, Hough, MB. Nosocomial infections related to fibreoptic intubation. Anaesthesia 2000; 55: 816–817.CrossRefGoogle ScholarPubMed
11.Jenkins, SA, Marshall, CF. Awake intubation made easy and acceptable. Anaesth Intensive Care 2000; 28: 556–561.CrossRefGoogle ScholarPubMed
12.Schmitt, HJ, Mang, H, Schmidt, J, Zenk, J, Radespiel-Troger, M. Fibreoptic intubation in patients after radiotherapy for carcinoma of the head and neck: difficulty and predictability. Eur J Anaesthesiol 2004; 21: 925–927.Google Scholar
13.McGuire, G, el-Beheiry, H. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures. Can J Anaesth 1999; 46: 176–178.CrossRefGoogle ScholarPubMed
14.Ho, AM, Chung, DC, To, EW, Karmakar, MK. Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway. Can J Anaesth 2004; 51: 838–841.Google Scholar
15.Cara, DM, Norris, AM, Neale, LJ. Pain during awake nasal intubation after topical cocaine or phenylephrine/lidocaine spray. Anaesthesia 2003; 58: 777–780.CrossRefGoogle ScholarPubMed
16.Mishra, S, Bhatnagar, S, Jha, RR, Singhal, AK. Airway management of patients undergoing oral cancer surgery: a retrospective study. Eur J Anaesthesiol 2005; 22: 510–514.CrossRefGoogle ScholarPubMed
17.Ovassapian, A, Yelich, SJ, Dykes, MH, Brunner, EE. Fiberoptic nasotracheal intubation – incidence and causes of failure. Anesth Analg 1983; 62: 692–695.Google Scholar
18.Aoyama, K, Yasunaga, E, Takenaka, I, Kadoya, T, Sata, T, Shigematsu, A. Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques. Br J Anaesth 2002; 88: 246–254.Google Scholar
19.Erb, T, Hampl, KF, Schurch, M, Kern, CG, Marsch, SC. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg 1999; 89: 1292–1295.Google Scholar
20.Kazama, T, Ikeda, K, Morita, K, Katoh, T, Kikura, M. Propofol concentration required for endotracheal intubation with a laryngoscope or fiberscope and its interaction with fentanyl. Anesth Analg 1998; 86: 872–879.Google ScholarPubMed
21.Andel, H, Klune, G, Andel, D et al. . Propofol without muscle relaxants for conventional or fiberoptic nasotracheal intubation: a dose-finding study. Anesth Analg 2000; 91: 458–461.Google Scholar
22.Langeron, O, Semjen, F, Bourgain, JL, Marsac, A, Cros, AM. Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management. Anesthesiology 2001; 94: 968–972.Google Scholar
23.Billard, V, Cazalaa, JB, Servin, F, Viviand, X. Target-controlled intravenous anesthesia. Ann Fr Anesth Reanim 1997; 16: 250–273.Google Scholar
24.Passot, S, Servin, F, Allary, R et al. . Target-controlled versus manually-controlled infusion of propofol for direct laryngoscopy and bronchoscopy. Anesth Analg 2002; 94: 1212–1216 [table of contents].CrossRefGoogle ScholarPubMed
25.Joo, HS, Kapoor, S, Rose, DK, Naik, VN. The intubating laryngeal mask airway after induction of general anesthesia versus awake fiberoptic intubation in patients with difficult airways. Anesth Analg 2001; 92: 1342–1346.CrossRefGoogle ScholarPubMed
26.Benumof, JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology 1991; 75: 1087–1110.Google ScholarPubMed
27.Smith, JE, Fenner, SG, King, MJ. Teaching fibreoptic nasotracheal intubation with and without closed circuit television. Br J Anaesth 1993; 71: 206–211.CrossRefGoogle ScholarPubMed