Airway anesthesia for awake fiberoptic intubation in management of pediatric difficult airways

2008 ◽  
Vol 18 (12) ◽  
pp. 1264-1265 ◽  
Author(s):  
Fu Shan Xue ◽  
Mao Ping Luo ◽  
Ya Chao Xu ◽  
Xu Liao
Keyword(s):  
Fiberoptic Intubation ◽  
Difficult Airways ◽  
Awake Fiberoptic Intubation

scholarly journals Sevoflurane for fiberoptic intubation in patients with pharyngeal or laryngeal tumor and severe comorbidities: A retrospective analysis

2021 ◽  
Author(s):  
Andreas Friedrich Christoph Breuer-Kaiser ◽  
Ana Nicolaescu ◽  
Jennifer Herzog-Niescery ◽  
Martin Bellgardt ◽  
Heike Vogelsang ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Spontaneous Breathing ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Risk Patients ◽  
Secondary Endpoints ◽  
Difficult Airways ◽  
Awake Fiberoptic Intubation ◽  
Sedative Drugs ◽  
Vital Parameters

Abstract Background: Current guidelines recommend fiberoptic intubation as the gold standard for intubating patients with “difficult airways.” An awake, spontaneously breathing patient provides some degree of safety; however, many patients require sedation. Sedation may impair spontaneous breathing and counteract the benefits of an “awake fiberoptic intubation.” Sevoflurane might be an alternative to intravenous sedative drugs as it preserves spontaneous breathing and provides patient comfort. For this, we implemented a sevoflurane-based protocol to improve the safety of fiberoptic intubation in high-risk patients with severe comorbidities.Methods: We enrolled 29 patients with pharyngeal or laryngeal carcinoma who had undergone fiberoptic intubation with sevoflurane due to a “difficult airway.” The primary endpoint was the preservation of spontaneous breathing during airway management. Secondary endpoints were drop in oxygen saturation to < 90%, the success rate and duration of intubation, the use of intravenous sedative drugs, changes in vital parameters, complications, and awareness. Results: Preservation of spontaneous breathing was possible in all procedures. Fiberoptic intubation was successful in 25 procedures. In three cases, a video laryngoscope was used. One patient suffering from an unidentified trans-cricoid fistula exhaled sevoflurane before an adequate depth of sedation was achieved. In this patient, oxygen saturation dropped to 71%. In the other 28 patients, oxygen saturation did not drop below 90%. The vital parameters did not change significantly. One fiberoptic intubation was complicated by epistaxis, and four patients had moderate bronchial spasm. None of the patients were able to recall the procedure. Conclusions: We concluded that a sevoflurane-based fiberoptic intubation in patients with “difficult airways” and relevant comorbidities is technically feasible. A trans-cricoid fistula is probably a contraindication for this approach.

scholarly journals Outcomes of Intubation in Difficult Airways Due to Head and Neck Pathology

2012 ◽  
Vol 91 (3) ◽  
pp. E1-E5 ◽  
Author(s):  
Tim A. Iseli ◽  
Claire E. Iseli ◽  
J. Blake Golden ◽  
Virginia L. Jones ◽  
Arthur M. Boudreaux ◽  
...  
Keyword(s):  
Difficult Airway ◽  
Head And Neck ◽  
Cancer Diagnosis ◽  
Adverse Outcomes ◽  
Common Method ◽  
Fiberoptic Intubation ◽  
Head And Neck Pathology ◽  
Difficult Airways ◽  
Awake Fiberoptic Intubation ◽  
The Impact

The purpose of this study was to examine the impact of surgical pathology, anesthesiologist experience, and airway technique on surgically relevant outcomes in patients identified by preoperative laryngoscopy to have a difficult airway due to head and neck pathology. We prospectively recorded a series of 152 difficult airway cases due to head and neck pathology out of 2,145 direct laryngoscopies undertaken between November 2005 and June 2008. One of two senior anesthesiologists specializing in head and neck procedures intubated 101 (66.4%) of the 152 patients and did so 3.3 minutes faster (p = 0.51), with better oxygenation (87.3 vs. 81.8%; p = 0.02) and fewer airway plan changes (p = 0.001) than did other, nonspecialist anesthesiologists. Predictors of failure of the first intubation plan included: cancer diagnosis (p = 0.02), previous radiotherapy (p = 0.03), and supraglottic lesions (p = 0.03). Glottic/subglottic lesions required the most intubation attempts (p = 0.02). Awake fiberoptic Intubation was the most common method used (44.7%) but resulted in a change in the airway plan in 6 cases (8.8%). Gas induction maintained the best oxygenation (p = 0.01). Awake tracheostomy was infrequent (1.3%) and took the longest (p = 0.006). We concluded that difficult airways due to head and neck pathology require teamwork and a backup plan. An anesthesiologist specializing in head and neck procedures may help to avoid adverse outcomes associated with cancer, especially previously irradiated supraglottic/glottic lesions, leading to a less frequent need for awake tracheostomy.

scholarly journals Acute Awake Fiberoptic Intubation in the ICU in a Patient with Limited Mouth Opening and Hypoxemic Acute Respiratory Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kjartan E. Hannig ◽  
Rasmus W. Hauritz ◽  
Christian Jessen ◽  
Anders M. Grejs
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Mouth Opening ◽  
Fiberoptic Intubation ◽  
Limited Mouth Opening ◽  
Emergency Airway ◽  
Hypoxemic Acute Respiratory Failure ◽  
Feasible Option ◽  
Difficult Airways ◽  
Awake Fiberoptic Intubation

The incidence and survival of patients with head-and-neck cancer have been on the increase for decades. Following surgery or radiation therapy, complications such as difficult airways may evolve. These difficult airways may be unique and not manageable with conventional intubation methods as well as video laryngoscopes. Acute awake fiberoptic intubation may be a feasible option also for urgent emergency airway management of known difficult airways. The “cannot intubate–cannot oxygenate” (CI–CO) situation has to be avoided at all costs, since emergency cricothyrotomy has a fail ratio of more than 50% when performed by an anesthesiologist.

scholarly journals Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

2020 ◽  
Author(s):  
Chunzhu Li ◽  
Jiali Peng ◽  
Yu Sun ◽  
Rong Hu ◽  
Hao Wang ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Fiberoptic Intubation ◽  
Administration Routes ◽  
Vas Score ◽  
Group 4 ◽  
Group 6 ◽  
Difficult Airways ◽  
Group 5 ◽  
Awake Fiberoptic Intubation ◽  
Group 1

Abstract Background: Awake fiberoptic bronchoscope intubation (AFOBI) is the gold standard technique for the management of patients with difficult airways. Adequate sedation and analgesia are essential for successful AFOBI. The aim of this study was to evaluate the sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation. Methods: Patients undergoing head and neck surgery under general anesthesia with predicted difficult airways were included. Participants were randomly assigned to 6 different groups (n=6): groups 1-3 were intravenous (IV), while groups 4-6 were intranasal(IN) (group 1: dexmedetomidine (DEX) 1 μg/kg + fentanyl (FEN) 1 μg/kg; groups 2-3: DEX 1 μg/kg+ FEN 0.7 μg/kg + ketamine (KTM) 0.1/0.2 mg/kg; group 4: DEX 1.5 μg/kg + FEN 1.4 μg/kg; and groups 5-6: DEX 1 μg/kg + FEN 1 μg/kg + KTM 0.4/0.6 mg/kg). The visual analog scale (VAS) score during intubation, time required for the modified observer’s assessment of alertness/sedation scale (OAA/S) score to reach above 2 and for the bispectral index (BIS) to decrease to 60-80, motor activity assessment scale (MAAS) score, changes in vital signs and adverse effects were recorded. Results: Among the IV groups, the VAS score of group 1 (5.65±2.11) was higher than those of group 2 (1.89±2.16, P =0.012) and group 3 (1.15±0.98, P =0.001). Among the IN groups, the VAS score was lower in group 6 (0.86±1.27) than in group 4 (7.20±2.70, P <0.001) and group 5 (3.93±2.73, P =0.031). Participants in group 5 and group 6 were less likely to cough when intubated than those in group 4 ( P =0.002), while the differences among IV groups were not significant. There were no significant differences in the other endpoints. Conclusions: Our study indicates that the addition of subanesthetic doses of ketamine, either intravenous or intranasal, could reduce the fentanyl and dexmedetomidine consumption used in AFOBI and provide better sedative and analgesic effects. Trial registration: Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR1900021185), prospectively registered on February 1st, 2019.

scholarly journals Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

2020 ◽  
Author(s):  
Chunzhu Li ◽  
Jiali Peng ◽  
Yu Sun ◽  
Rong Hu ◽  
Hao Wang ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Fiberoptic Intubation ◽  
Administration Routes ◽  
Vas Score ◽  
Group 4 ◽  
Group 6 ◽  
Difficult Airways ◽  
Group 5 ◽  
Awake Fiberoptic Intubation ◽  
Group 1

Abstract Background: Awake fiberoptic bronchoscope intubation (AFOBI) is the gold standard technique for the management of patients with difficult airways. Adequate sedation and analgesia are essential for successful AFOBI. The aim of this study was to evaluate the sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation.Methods: Patients undergoing head and neck surgery under general anesthesia with predicted difficult airways were included. Participants were randomly assigned to 6 different groups (n = 6): groups 1-3 were intravenous (IV), while groups 4-6 were intranasal (IN) (group 1: dexmedetomidine (DEX) 1 μg/kg + fentanyl (FEN) 1 μg/kg; groups 2-3: DEX 1 μg/kg + FEN 0.7 μg/kg + ketamine (KTM) 0.1/0.2 mg/kg; group 4: DEX 1.5 μg/kg + FEN 1.4 μg/kg; and groups 5-6: DEX 1 μg/kg + FEN 1 μg/kg + KTM 0.4/0.6 mg/kg). The visual analog scale (VAS) score during intubation, time required for the modified observer’s assessment of alertness/sedation scale (OAA/S) score to reach above 2 and for the bispectral index (BIS) to decrease to 60-80, motor activity assessment scale (MAAS) score, changes in vital signs and adverse effects were recorded.Results: Among the IV groups, the VAS score of group 1 (5.65 ± 2.11) was higher than those of group 2 (1.89 ± 2.16, P = 0.012) and group 3 (1.15 ± 0.98, P = 0.001). Among the IN groups, the VAS score was lower in group 6 (0.86 ± 1.27) than in group 4 (7.20 ± 2.70, P < 0.001) and group 5 (3.93 ± 2.73, P = 0.031). Participants in group 5 and group 6 were less likely to cough when intubated than those in group 4 (P = 0.002), while the differences among IV groups were not significant. There were no significant differences in the other endpoints.Conclusions: Our study indicates that the addition of subanesthetic doses of ketamine, either intravenous or intranasal, could reduce the fentanyl and dexmedetomidine consumption used in AFOBI and provide better sedative and analgesic effects.Trial registration: Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR1900021185), prospectively registered on February 1st, 2019.

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