Pressure support ventilation during fibreoptic intubation under propofol anaesthesia.

Abstract

GOAL OF THE STUDY:

To assess the benefit of pressure support ventilation during fibreoptic intubation performed under propofol anaesthesia in patients having an anticipated difficult intubation.

PROCEDURES:

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.

CONCLUSION:

Pressure support represents a useful method to improve ventilation during fibreoptic intubation under propofol anaesthesia in patients with an anticipated difficult intubation.

• Authors: J L Bourgain, V Billard, A M Cros
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 98 Issue 1 Pg. 136-40 (Jan 2007) ISSN: 0007-0912 [Print] England
• PMID: 17142824 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Intravenous
• Carbon Dioxide
• Oxygen
• Propofol

Topics

• Aged
• Anesthetics, Intravenous
• Carbon Dioxide (physiology)
• Fiber Optic Technology
• Head and Neck Neoplasms (therapy)
• Humans
• Intubation, Intratracheal (methods)
• Middle Aged
• Oxygen (blood)
• Propofol
• Prospective Studies
• Respiration, Artificial (methods)
• Risk Factors
• Tidal Volume