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 Dexmedetomidine in the Management of Awake Fiberoptic Intubation

2019 ◽  
Vol 13 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Aniello Alfieri ◽  
Maria B. Passavanti ◽  
Sveva Di Franco ◽  
Pasquale Sansone ◽  
Paola Vosa ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Practice Guidelines ◽  
Gold Standard ◽  
Fibreoptic Intubation ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Difficult Airway Management ◽  
Patient Discomfort ◽  
Awake Fiberoptic Intubation

Awake Fibreoptic Intubation (AFOI) is, nowadays, the gold standard in predicted difficult airway management. Numerous practice guidelines have been developed to assist clinicians facing with a difficult airway. If conducted without sedation, it is common that this procedure may lead to high patient discomfort and severe hemodynamic responses. Sedation is frequently used to make the process more tolerable to patients even if it is not always easy to strike a balance between patient comfort, safety, co-operation, and good intubating conditions. In the last years, many drugs and drug combinations have been described. This minireview aims to discuss the evidence supporting the use of Dexmedetomidine (DEX) in the AFOI management.

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 A PROSPECTIVE RANDOMIZED STUDY TO EVALUATE THE ANALGESIC AND SEDATIVE EFFECTS OF FENTANYL AND MIDAZOLAM TO NALBUPHINE AND MIDAZOLAM IN PATIENTS UNDERGOING AWAKE FIBEROPTIC

2021 ◽  
Vol 9 (09) ◽  
pp. 530-538
Author(s):  
Akshat Taneja ◽  
◽  
Akash Gupta ◽  
Malti Agrawal ◽  
Upasana Asooja ◽  
...  
Keyword(s):  
Difficult Airway ◽  
Pressor Response ◽  
Randomized Study ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Intubation Attempt ◽  
Intubation Time ◽  
Intubating Conditions ◽  
Sedative Effects ◽  
Awake Fiberoptic Intubation

Background- Awake nasal or oral flexible fiberoptic intubation (AFOI) is technique of choice in known or anticipated difficult airway . The main aim was to have calm and cooperative patient who can follow verbal commands while maintaining adequate oxygenation . In our study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubationmore tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Material and Methods– A prospective, randomized comparison study among patients between the age of 18 and 60yrs of either sex, with anticipated difficult airway . We compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubation. The primary objectives of our study were to observe the level of sedation, intubation score and OAS score after completion of procedure. The secondary objectives included assessment of patient comfort, intubation time, hemodynamic changes and complications. Results – We found that comfort score and intubation time were significant lesser in Group which received fentanyl and midazolam than Group which received nalbuphine and midazolam . (p<0.05). The intubation attempt was similar in both groups (P>0.05). Conclusion– we concluded that both regimens used in this study provided comparable intubating conditions, better sedation and analgesia was observed in group fentanyl for airway procedure events. Our study concluded fentanyl to be the drug of choice for blunting of pressor response in such patients.

scholarly journals Comparison of Dexmedetomidine vs Midazolam for Sedation during Awake Fiberoptic Intubation in Oral Cancer Surgeries- A Randomised Clinical Study

2021 ◽  
Author(s):  
Reema Meena ◽  
Adhokshaj Joshi ◽  
KM Sherbina ◽  
Purbali Singha Roy
Keyword(s):  
Oral Cancer ◽  
Normal Saline ◽  
Nasotracheal Intubation ◽  
Patient Comfort ◽  
Fiberoptic Intubation ◽  
Double Blind Study ◽  
Number Of Patients ◽  
Group 2 ◽  
Awake Fiberoptic Intubation ◽  
Group 1

Introduction: Fiberoptic nasotracheal intubation is a prime method for managing difficult airway in patients. Besides local blocks, some sedation is required during the procedure to make it more tolerable to the patients. Dexmedetomidine (DEX) and Midazolam (MDZ) can be used for this purpose. Aim: To compare dexmedetomidine versus midazolam for sedation and intubating condition during Awake Fiberoptic Intubation (AFOI) in patients undergoing oral cancer surgeries. Materials and Methods: This was a prospective randomised double blind study on total of 60 patients randomly allocated into group 1(MDZ) and group 2(DEX). Group 1 received intravenous (i.v.) Midazolam 0.05 mg/kg bolus in 10 mL normal saline over 10 minutes followed by 0.1 mg/kg/hr infusion titrated upto 0.2 mg/ kg/hr to achieve a Ramsay Sedation Score (RSS) ≥2. Group 2 (DEX) received i.v. Dexmedetomidine 1 μg/kg bolus in 10 mL normal saline over 10 minutes followed by infusion at the rate of 0.2 μg/kg/ hr titrated upto 0.7 μg/kg/hr to achieve a RSS ≥2. Comfort Scale values, haemodynamic parameters, patient’s tolerance score and patient’s satisfaction score (24 hours after the surgery) were assessed. Significance was calculated using Student t-test. The number of patients with adverse effects was compared using Chi- square test. Results: In the total sample of 60 patients (30 subjects in MDZ group and 30 subjects in DEX group). The demographic data, blood pressure and Oxygen(O2) saturation were comparable. Significant change in Heart Rate (HR) was observed in group MDZ while HR was stable in DEX group (p<0.001). Group DEX patients were more comfortable and had greater endurance with tolerance score <2.5 compared to MDZ group >2.5 (p<0.001) and had an acceptable level of RSS. After 24 hours, DEX group patients judged their sedation more positively than MDZ group with a score of 6.16 vs. 3.6 (p<0.001). Conclusion: Both Midazolam and Dexmedetomidine are effective for AFOI. But Dexmedetomidine provided better patient comfort and satisfaction along with stable haemodynamics.

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.

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