Abstract
Purpose
“To evaluate the use of inhalational induction followed by intubation through the intubating laryngeal mask (ILM) for patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.
Methods
Nine patients undergoing a total of II procedures were enrolled in the study. Fentanyl 2μg·kg−1 midazolam 0.035 mg·kg−1 and sevoflurane in oxygen 100% were used for induction. The ILM was inserted when the end-tidal sevoflurane concentration reached 3%. After an effective airway was established, atracurium 0.5 mg·kg−1 was given. A polyvinyl chloride tube in the reversed position using a blind technique was used to intubate the trachea.
Results
The ILM provided an effective airway on 11/11 occasions at the first attempt. Intubation was successful at the first attempt on 7/11 occasions, at the second attempt on 2/11 and at the third attempt in 1/11. Intubation failed in one patient. The mean (range) minimal oxygen saturation was 99.4% (97–100%). There were no problems with ILM removal.
Conclusion
Inhalational induction followed by ILM insertion and blind intubation is a reasonable option in patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.
Résumé
Objectif
Évaluer l’utilisation de l’induction par inhalation suivie de l’intubation au travers du masque laryngé d’intubation (MLI) chez des patients qui présentent une spondylarthrite ankylosante sévère, qui doivent subir une intervention non urgente, mais qui préfèrent une intubation sous anesthésie.
Méthode
Neuf patients, admis pour 11 interventions au total, ont été recrutés pour participer à l’étude. On a utilisé 2μg·kg−1 de fentanyl, 0,035 mg·kg−1 de midazolam et du sévoflurane dans de l’oxygène à 100 % pour l’induction anesthésique. On a ensuite inséré le MLI quand la concentration de sévoflurane de fin d’expiration a atteint 3 %. Après avoir assurer la liberté des voies respiratoires, on a administré 0,5 mg·kg−1 d’atracurium. On a utilisé un tube endotrachéal de chlorure de polyvinyle en position renversée pour réaliser l’intubation endotrachéale à l’aveugle.
Résultats
Le MLI a permis une perméabilité efficace des voies aériennes 11/11 fois au premier essai. L’intubation a été réussie au premier essai dans 7/11 cas, au second essai dans 2/11 cas et au troisième, dans un cas. L’intubation a été un échec chez un patient. La saturation minimale moyenne en oxygène (intervalle) a été de 99,4 % (97–100 %). Le MLI a été retiré sans difficulté.
Conclusion
L’induction par inhalation suivie de l’insertion d’un MLI et d’une intubation à l’aveugle apparaît comme une option possible chez des patients atteints de spondylarthrite ankylosante sévère qui préfèrent une intubation sous anesthésie.
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Lu, PP., Brimacombe, J., Ho, A.C.Y. et al. The intubating laryngeal mask airway in severe ankylosing spondylitis. Can J Anaesth 48, 1015–1019 (2001). https://doi.org/10.1007/BF03016593
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DOI: https://doi.org/10.1007/BF03016593