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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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