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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A532
October 18, 2009 2:00 PM - 4:00 PM Room Area N |
| Video-Assisted Fiberoptic Orotracheal Intubation under General Anesthesia |
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Florin Liviu Dimache, M.D., Johannes Wolter, M.D., Thomas Ravaz, M.D., Marko Lujic, M.D., Pierre Diemunsch, M.D., Ph.D. Anesthesiology, Strasbourg University Hospital, Strasbourg, France |
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Introduction:
The fiberoptic intubation (F) is generally accepted as the gold standard when facing a predicted difficult airway. Mastering the technique is rendered difficult because of the relative rarity of such situations in everyday practice. Acquiring the technique is accelerated by practicing on patients under general anesthesia (GA), with no sign of difficult airway [1] and facilitated by associating the videolaryngoscope [2]. The McGrath (MG, Aircraft Medical) is a portable videolaryngoscope designed for difficult airways. The goal of this observational study is to verify the feasibility and the potential advantages of MG+F association in facilitating fiberoptic intubation. Material and methods: After giving informed consent, patients undergoing elective neurosurgical interventions with an ASA I to III, requiring a fiberoptic intubation under GA (predictable difficult airway or a particular danger of direct laryngoscopy, with no predictable difficult mask ventilation) have been included. The standard protocol of GA included pre-oxygenation (3 min., FiO 2 = 1) followed by induction with propofol (TCI, 5ng/ml), sufentanil (3 μg/kg) and cis-atracurium (0.15 mg/kg). As soon the TOF=0/4 and FeO2 ≥85%, the fiberoptic orotracheal intubation was performed alone (group F) on odd weeks, or with the help of videolaryngoscopy (group MG+F) on even weeks. The mouth-to-carena time (t1), the total time from the beginning to the first capnography curve (t2), and the tracheal tube introducing time (t2-t1) were recorded. In case of failure (SpO 2 <94% or t1 > 240 sec.), a second attempt was made after further 3 minutes of mask ventilation. In case of two successive failures, the airway was controlled by a senior anesthesiologist. Cough, hoarseness and dysphagia were sought for in the recovery room. Results: 20 patients were included (10 F and 10 MG+F). Both groups were similar in terms of age, BMI or predictable DA. In the MC+F group, all patients were successfully intubated from the first attempt. The F group saw 1 failure and 2 patients needing a second attempt (NS). The t1, t2 and t2-t1 times were significantly lower in the MG+F group compared to the F group (104.5 ± 21.4 sec. vs . 175 ± 27.5 sec., p = 0.0003; 135 ± 25.9 sec. vs . 215 ± 25.2 sec., p= 0.0003; and 30.5 ± 11.4 sec. vs . 40 ± 7.9 sec., p< 0.05 for the MG+F and the F group, respectively). By the end of the procedure, there was no significant difference of mean SpO2 between the two groups. No intra or post operative complications were noticed in these series. Discussion: The MG+F association seems to accelerate the fiberoptic intubation of patients under GA. A larger study could evaluate other potential advantages of this association. References: 1. Anesthesiology 2001 Aug; 95(2):343-8 2. Can J Anaesth 2007 Jun; 54(6):492-3. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |