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La sédation au propofol permet l’intubation difficile vigile avec le masque laryngé Fastrach^TM

[Propofol sedation allows awake intubation of the difficult airway with the Fastrach^TM LMA]

Du Groupement d’Anesthésie et de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Tours, Tours, France.

Adresser la correspondance à: Dr Franck Hamard, Service d’anesthésie réanimation chirurgicale, Centre hospitalier universitaire de Tours, 2 boulevard Tonnelé, 37000 Tours, France. Téléphone : 02 47 47 38 10 ; Télécopieur : 02 47 47 46 60; Courriel : hamardf{at}voila.fr

Purpose: To evaluate target controlled infusion anesthesia (TCI) with propofol for conscious intubation [(Ramsay score equal to 3 (RS 3)] through the Fastrach^TM laryngeal mask airway (LMA)

Methods: 17 consenting and unpremedicated patients, who showed criteria for difficult intubation (score developed by Arné et al. 11), were monitored and received supplemental oxygen. Propofol was administered by TCI, with successive targets of 0.6 and 1 µg·mL^–1, while the RS was evaluated: if = 3, LMA intubation was attempted, if < 3 the TCI was increased by steps of 0.2 µg·mL^–1 until an RS of 3 was reached. Local anesthesia (lidocaine 5%) of the oropharynx was carried out at 0.6 and 1 µg·mL^–1, together with local anesthesia of the nasopharynx at 1 µg·mL^–1. A standardized questionnaire evaluated memory of and satisfaction with the technique (score/10) on postoperative day 1.

Results: The LMA was inserted in 100% of cases and intubation was successful in 16 out of 17 cases (one failure). The propofol target concentration to obtain a RS of 3 was 1.25 ± 0.07 µg·mL^–1. Amnesia occurred as soon as the target concentration of propofol exceeded 1 µg·mL^–1. The patients found the technique very satisfactory (median satisfaction score = 9.4/10). Incidents of coughing or nausea were observed in 47% and 5% of cases respectively. There was no oesophageal intubation and no desaturation (Sp0₂ < 95%).

Conclusion: Propofol administered by TCI to achieve a RS of 3 allows conscious intubation to be performed through a LMA under satisfactory conditions. A LMA could be a possible alternative to a "conscious" fibroscopy.

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