Intubation difficile en chirurgie cervicofaciale

Difficult intubation is more common in patients with head and neck pathology than in general population. Prediction of difficult intubation uses the same criteria as usual; nevertheless, the predictive values of difficult intubation scores are low except if several criteria are used. In this setting, fibre optic intubation is the gold standard because Fastrach® is commonly contraindicated or fails frequently. Fibre optic intubation may be difficult and should be performed by an experimented anaesthesiologist. Supplemental oxygen is provided to the spontaneously breathing patient, sedated by either propofol or remifentanil. Whatever the intubation technique, the risk for arterial desaturation in oxygen should be taken into account. Transtracheal ventilation is helpful but may be responsible for serious complications that occur more frequently with manual techniques. Use of dedicated jet ventilator with automatic control of tracheal pressure is recommended.