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 LOCALANAESTESIA FOR AWAKE FIBEROPTIC INTUBATION: A COMPARISON OF TWO TECHNIQUES- AIRWAY NERVE BLOCKS VS 'SPRAY AS YOU GO' TECHNIQUE

2020 ◽  
pp. 1-4
Author(s):  
Priyanka Mankar ◽  
Girish Saundattikar
Keyword(s):  
Difficult Airway ◽  
Local Anesthesia ◽  
Nerve Block ◽  
Superior Laryngeal Nerve ◽  
Fiberoptic Intubation ◽  
Intubation Time ◽  
Nerve Blocks ◽  
Intubating Conditions ◽  
Number Of Patients ◽  
Awake Fiberoptic Intubation

Background- Awake fiberoptic intubation is the recommended technique for anticipated difficult airway management which requires effective local anesthesia for patient's comfort and co-operation. In this study, we compared airway nerve blocks and “Spray as you go” technique for awake fiberoptic intubation in difficult airway patients. Method- Sixty adult patients with an anticipated difficult airway with Mallampati Class III and IV were selected and randomized into two groups for awake fiberoptic intubation. Each group receiving lignocaine as a local anesthetic with either of two different methods. Group A (n=30) via airway nerve blocks using transtracheal and superior laryngeal nerve block; and group B (n=30) via intubating fiberscope using ‘spray as you go’ technique. We compared two groups using the Number of attempts for intubation, Intubation time, Intubating conditions, Cough count, Hemodynamic response, Severity scale [patients comfort], and the additional required dose of lignocaine used. Descriptive statistics were done for all data. p-value<0.05 was considered statistically significant. The result- we found that airway nerve blocks provide better local anesthesia by providing good intubating conditions with less cough count, less intubation time, and better hemodynamic stability as compare to spray as you go group. None of the patients showed any evidence of lignocaine toxicity. But an additional dose of lignocaine used was significantly more number of patients in the spray as you go, group. However patient comfort and acceptance is equal in both groups as patient severity score was the same in both groups and all patients got successfully intubated in both the groups Conclusion- airway nerve block technique of local anesthesia is better than spray as you go method however spray as you go technique can be used in cases where airway blocks are not possible.

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.

Difficult Airway caused by a Subglottic Tumor: A Case Report

2019 ◽  
Author(s):  
Xuefei Ye ◽  
Xiaofeng Jiang ◽  
Haiyan Lan ◽  
Yun Yang ◽  
Qingquan Lian
Keyword(s):  
Case Report ◽  
Difficult Airway ◽  
Tumor Resection ◽  
Awake Intubation ◽  
Fiberoptic Intubation ◽  
Intubation Attempt ◽  
Anesthesia Induction ◽  
Laryngeal Tumor ◽  
Emergency Tracheostomy ◽  
Awake Fiberoptic Intubation

Abstract Background: Securing the airway is a core skill for an anesthesiologist, the gold standard of which is tracheal intubation. Patient with subglottic tumor is a situation of difficult airways and could be a challenge for anesthesiologists. The “cannot ventilate, cannot intubate” during anesthesia induction can be lethal. So we always prepared awake approach for diagnosed difficult airway, but awake fiberoptic intubation may be also failed. Case presentation: In this case report we present a 55 years old female patient was scheduled for laryngeal tumor resection, and was planned awake intubation guided by fiber bronchoscope. After awake intubation attempt failed, emergency tracheostomy was successfully completed by ENT surgeon. After securing airway, general anesthesia was performed and the operation proceeded with laryngeal tumor resection. Conclusions: It is important that ENT surgeon must be asked to remain standby for possible need of emergency tracheostomy to prevent awake fiberoptic intubation failure. Ultrasound or computed tomography scan examination of the trachea may be useful to provide guidance for anesthesiologists to choose the appropriate endotracheal tube IDs or tracheostomy directly by measuringthe degree of airway stenosis. Keywords: Subglottic Tumor; difficult airway; ENT; anesthesia

Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Waleed Mohamed Abd El Mageed ◽  
Ahmad Kamal Mohamed Ali ◽  
Eeman Aboubakr ElSiddik Ahmed Bayoumi ◽  
Haitham Sabry Mahmoud Omar
Keyword(s):  
Cervical Spine ◽  
Sedation Score ◽  
Fiberoptic Intubation ◽  
Intubation Time ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B ◽  
Awake Fiberoptic Intubation

Abstract Background Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects. Aim The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation. Material and Methods A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups. Results Ramsy Sedation Score was significantly favorable (P &lt; 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P &lt; 0.05) and less intubation attempts were observed in group A in comparison to group B. Conclusion The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.

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 Comparison of Cricothyroid Membrane Puncture Anesthesia and Topical Anesthesia for Awake Fiberoptic Intubation: A Double-Blinded Randomized Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Shaocheng Wang ◽  
Chaoli Hu ◽  
Tingting Zhang ◽  
Xuan Zhao ◽  
Cheng Li
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Controlled Trial ◽  
Topical Anesthesia ◽  
Fiberoptic Intubation ◽  
Intubation Time ◽  
Cricothyroid Membrane ◽  
Hemodynamic Changes ◽  
Anesthesia Group ◽  
Awake Fiberoptic Intubation

Background: Awake fiberoptic intubation (AFOI) is commonly used for patients with a difficult airway. The purpose of this study was to evaluate the efficacy of cricothyroid membrane puncture anesthesia and topical anesthesia during AFOI.Methods: A total of 70 patients (the American Society of Anesthesiologists score I-III) with anticipated difficult airways scheduled for nonemergency surgery with AFOI were randomly slated to receive cricothyroid membrane puncture anesthesia (n = 35) or topical anesthesia (n = 35). Each group received dexmedetomidine at a dose of 1.0 μg/kg and sufentanil at a dose of 0.2 μg/kg over 10 min for conscious sedation before intubation. The endoscopy intubation, post-intubation condition, and endoscopy tolerance as scored by the anesthetists were observed. The satisfaction of the operator regarding the procedure and the satisfaction of the patient 24 h after the surgery were also recorded. We recorded the success rate of the first intubation, intubation time, and hemodynamic changes during the procedure and also the adverse events.Results: Better intubation scores, operator satisfaction, and satisfaction of the patient were observed in the cricothyroid membrane puncture anesthesia group than in the topical anesthesia group (p &lt; 0.05). The intubation time in the cricothyroid membrane puncture anesthesia group was less than that in the topical anesthesia group (p &lt; 0.05). There were no significant differences in the patient tolerance scores, the success rate of the first intubation, hemodynamic changes, and adverse events between both the groups.Conclusion: Compared with topical anesthesia, cricothyroid membrane puncture anesthesia provided better intubation conditions and less intubation time with greater satisfaction of the patient and operator during endoscopic intubation.Clinical Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=42636, Identifier: ChiCTR 1900025820.

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