Abstract
We studied thirty-five patients of ASA physical status I and II with difficult airway to compare a bolus inhalation of sevoflurane with a target-controlled infusion (TCI) of propofol for establishment of the safety and feasibility of a novice training program for fiberoptic intubation. Patients were randomly assigned to three study groups : a group receiving a bolus inhalation of 5% sevoflurane (SVIMA group ; n = 15), and two groups receiving an effect-site concentration of either 2.8 or 4.0μg·ml-1 of propofol (LTCI group or HTCI group, respectively ; n = 10 each). Time with loss of response to verbal commands was significantly shorter (p < 0.01) in this order SVIMA, HTCI and LTCI groups. Respiratory depression (apnea for > 30s) occurred significantly more (p < 0.05) in the HTCI group than in the SVIMA group. Three patients in LTCI group demonstrated BIS value > 75 during an intubational procedure. Mean artery pressures and heart rates after tracheal intubation increased significantly more in the SVIMA and HTCI groups compared with their baselines. Incidence of adverse effects related to tracheal intubation such as coughing and laryngospasm was similar in all study groups. These results suggested that a bolus inhalation of 5% sevoflurane was superior to propofol TCI on fiberoptic nasotracheal intubation in terms of maintaining spontaneous breathing and hypnotic effects during the intubation procedure except for large hemodynamic changes after tracheal intubation.
