-The clinical use of the cuffed oropharyngeal airway (COPA)-. / Utilisation clinique du COPA (cuffed oropharyngeal airway).

OBJECTIVE: To assess the performance of the COPA device during general anaesthesia. STUDY DESIGN: Prospective, clinical, open study. PATIENTS: Eighty patients scheduled for short elective surgical procedures under general anaesthesia not requiring tracheal intubation. METHOD: After premedication (midazolam, atropine), anaesthesia was induced with propofol (154 +/- 40 mg = 2.47 +/- 0.8 mg.kg-1) and alfentanil (1.14 +/- 0.43 mg). The COPA device was inserted in a fashion similar to a Guedel airway device. The device was evaluated on the following criteria: correct choice of COPA size, ease of insertion, ability to obtain or maintain patent airway. Adverse reactions were noted, such as coughing, nausea, regurgitation, inhalation, and sore throat. The overall rating of the COPA as a "hand free device" was evaluated on the basis of excellent, good, fair, and poor. RESULTS: Insertion of the device was easy and in 70 cases successful on the first attempt. Jaw thrust on head tilt was necessary in half the cases. No patient necessitated intubation because of hypoxaemia or airway obstruction. Adverse reactions occurred in few cases and consisted of sore throat (always moderate) in 10% of the cases. COPA was evaluated as excellent or good in 80% of the cases. CONCLUSION: COPA is a convenient device for airway management in fasting patients undergoing general anaesthesia for elective surgery in the supine position, in whom tracheal intubation is not indicated.

[Intraoperative exchange of the endotracheal tube using the Cook C-CAE airway exchange catheter]. / Changement peropératoire de sonde endotrachéale à l'aide du guide échangeur creux C-CAE (Cook).

The Cook airway exchange catheter is mainly used in ICU patients to exchange endotracheal tubes. We report three cases where this device was used during anaesthesia in patients with damaged tubes in critical circumstances (oropharyngeal bleeding, head and neck surgery). It allowed a fast and atraumatic exchange of the tubes.

[Cervicofacial cellulitis of dental origin and tracheal intubation]. / Cellulites cervico-faciales d'origine dentaire et intubation trachéale.

OBJECTIVES: To evaluate the difficulty of intubation in relation with the localisation and spread of cervico-facial cellulitis of odontogenic origin and to recognize the optimal technique of intubation in such circumstances. STUDY DESIGN: Prospective clinical open study. PATIENTS: Hundred patients, including 16 children, undergoing surgical drainage of a cervico-facial cellulitis of odontogenic origin under general anesthesia were studied. METHODS: Difficulty of intubation was evaluated with the following four criteria: active mouth opening in the awake patient, Mallampati's classifying system, presence of trismus, clinical and radiological control of localisation and extension of the cellulitis (mandibular, maxillar or mouth floor). In case of a foreseen difficult intubation, a fibrescope was used in the awake patient. Otherwise the endotracheal tube was inserted after administration of propofol (3 mg.k-1) and alfentanil (10 to 20 micrograms.kg-1). A Cormack's grading was performed during intubation. RESULTS: Mouth opening depended on the localisation of the cellulitis. Trismus occurred more often with mandibular than maxillary localisations. Trismus and a Mallampati's class > 2 were associated with difficulty in intubation (Cormack's grade > 2), except in maxillary localisations. CONCLUSIONS: The localisation of cellulitis of odontogenic origin is responsible for the difficulty grade of intubation. Awake fibreoptic intubation should be systematically performed in patients with a floor of the mouth cellulitis to reduce the risk of rupture of the abscess by a laryngoscope blade. As trismus associated with mandibular localisations is not relieved by general anaesthesia, awake fibreoptic endotracheal intubation should be preferred.

Intermittent left bundle branch block revealed during anaesthesia.

Intermittent left bundle branch block is uncommon. During anaesthesia,, left bundle branch block may be related to hypertension or tachycardia and its occurrence makes the diagnosis of acute myocardial ischaemia or infarction difficult. Patients with intermittent left bundle branch block often develop established left bundle branch block, which may represent an earlier state of ischaemic heart disease. Cardiological investigation of our patient after operation did not point towards an organic cause of intermittent left bundle branch block.