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Le propofol pour réaliser une rachianesthésie en position latérale chez les victimes d’une fracture du fémur

[Propofol to facilitate spinal anesthesia in the lateral position in patients with femoral neck fracture]

Vincent Minville, MD^*, Adeline Castel, MD^*, Karim Asehnoune, MD PhD, Clément Chassery, MD^*, Jean-Michel Lafosse, MD, Luc Nguyen, MD^*, Aline Colombani, MD^* and Olivier Fourcade, MD PhD^*

^* Du Département d’anesthésie et de réanimation, CHU Toulouse-Rangueil, Université Paul Sabatier, Toulouse ;
Département d’anesthésie et de réanimation, Hôpital Paul Brousse, Villejuif ; et
le Service de chirurgie orthopédique et de traumatologie, CHU Toulouse-Rangueil, Toulouse, France.

Addresser la correspondance à: Dr Vincent Minville, Département d’anesthésie et de réanimation, CHU Toulouse - Rangueil, Université Paul Sabatier, 1, Avenue Jean Poulhès, 31400 Toulouse, France. Téléphone : 33 5 61 32 27 12 ; Télécopieur : 33 5 61 32 22 32 ; Courriel : vincentminville{at}yahoo.fr

Purpose: The aim of this study was to assess the feasibility and efficacy of propofol before positioning elderly patients with a femoral neck fracture in the lateral decubitus position, to perform a spinal anesthetic.

Methods: In this prospective and descriptive study, 79 consecutive patients, > 75 yr old, with a femoral neck fracture were included. Propofol, 0.5 mg·kg^–1, was administered. If loss of consciousness was not obtained (Ramsay score 3/6), then additional doses of 0.25 mg.kg^–1 were given until a Ramsay score of 4 or 5 was attained. Then, the patient was turned to the lateral decubitus position, the fractured side up. The efficacy of propofol was assessed by observing a grimace during positioning and asking the patients if they had recall of pain. Hemodynamic data and oxygen saturation were collected.

Results: Forty-three patients required a single injection, 34 required two injections and only two patients required three injections. No grimace and no recall of pain were recorded during the study. There was no desaturation (SpO₂ < 92 %), and hypotension, defined as a systolic blood pressure decrease > 30% from baseline, was observed.

Conclusion: Propofol is a simple and efficacious means of providing comfort while positioning elderly patients with a femoral head fracture before performing spinal anesthesia.

This article has been cited by other articles:

				A. Rabinowitz, B. Bourdet, V. Minville, C. Chassery, A. Pianezza, A. Colombani, B. Eychenne, K. Samii, and O. Fourcade The Paramedian Technique: A Superior Initial Approach to Continuous Spinal Anesthesia in the Elderly Anesth. Analg., December 1, 2007; 105(6): 1855 - 1857. [Abstract] [Full Text] [PDF]

				C. L. Errando A propos de l'utilisation du propofol pour la mobilisation des patients atteints de fracture de la hanche [Propofol to facilitate mobilization of patients with a hip fracture] Can J Anesth, September 1, 2007; 54(9): 771 - 771. [Full Text] [PDF]

				V. Minville and A. Colombani REPONSE Can J Anesth, September 1, 2007; 54(9): 771 - 772. [Full Text] [PDF]