Preparation for Advanced Airway Management: Preparation for Awake Intubation

2019 ◽  
Author(s):  
Arpan Mehta ◽  
Adrian Pichurko
Keyword(s):  
Nerve Block ◽  
Local Anesthetic ◽  
Superior Laryngeal Nerve ◽  
Management Plan ◽  
Laryngeal Nerve ◽  
Awake Intubation ◽  
Nerve Blocks ◽  
Local Anesthetic Toxicity ◽  
Safe Management ◽  
Management Preparation

Awake intubation is a key technique in anesthesia, allowing for the safe management of a patient with signs and predictors of a difficult airway/intubation. It is commonly undertaken electively, but can also be used in an emergency. An appropriate history must be taken, along with review of investigations (e.g CT scan, nasendoscopy), followed by a physical examination and development of a safe management plan. A variety of local anesthetic methods exist for topicalization of the airway (2-4% lidocaine), including nerve blocks (glossopharyngeal, recurrent laryngeal, superior laryngeal) to assist this. Sedation and amnesic techniques commonly include the use of benzodiazepines (midazolam), opioids (remifentanil infusion) and alpha agonists (dexmedetomidine). Knowledge of the side effects of these are paramount, including the cardiac and central nervous system with local anesthetic toxicity. 20% lipid emulsions are available in the event of this. This review contains 4 figures, 5 tables, and 25 references. Keywords: awake flexible bronchoscopic intubation, awake endoscopic intubation, remifentanil, dexmedetomidine, airway anesthesia, glossopharyngeal nerve block, recurrent laryngeal nerve block, superior laryngeal nerve block, local anesthetic toxicity, lipid emulation.

scholarly journals Upper Airway Nerve Block for Rigid Bronchoscopy in the Patients with Tracheal Stenosis: A Case Serie

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Parviz Amri ◽  
Novin Nikbakhsh ◽  
Seyed Reza Modaress ◽  
Ramin Nosrati
Keyword(s):  
Respiratory Distress ◽  
Nerve Block ◽  
Tracheal Stenosis ◽  
Superior Laryngeal Nerve ◽  
Upper Airway ◽  
Rigid Bronchoscopy ◽  
Laryngeal Nerve ◽  
Intravenous Sedation ◽  
Nerve Blocks

Background: Rigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress. Objectives: We introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks. Methods: This prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded. Results: From 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient. Conclusions: The upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.

COMPARISON OF ‘AIRWAY NERVE BLOCK’ VS ‘SPRAY-AS-YOU-GO’ METHOD USED FOR AWAKE FLEXIBLE BRONCHOSCOPIC INTUBATION IN COMBINATION WITH CONSCIOUS SEDATION – A PROSPECTIVE, RANDOMISED, SINGLE BLIND STUDY

2021 ◽  
pp. 3-6
Author(s):  
Devesh Kumar Gupta ◽  
Shinu Kaur ◽  
Deepti Gupta
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Nerve Block ◽  
Conscious Sedation ◽  
Nasotracheal Intubation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Mean ◽  
Lidocaine Spray ◽  
Single Blind

Introduction: Fibreoptic Intubation (FOI) is the gold standard for managing difcult airways. There are various approaches such as: Nebulization with lidocaine; 'Spray as you go'(SAYGO); Airway nerve block - blocking superior laryngeal nerve & recurrent laryngeal nerve & sedation. The present study aims to compare 'airway nerve block' (NB) and 'spray as you go'(SA) method for awake exible bronchoscopic intubation used in combination with conscious sedation. Methods: 60 patients of age group 18 – 65 years with difcult airway undergoing general anaesthesia with nasotracheal intubation, were randomly allocated into two groups. After premedication & nasal preparation, all patients received injection dexmedetomidine at a dose of 1µg/kg in 100ml of 0.9% NS over 10 minutes. In Group SA, 2ml lignocaine 4% was sprayed above and below the cords after visibility of glottic opening via working channel of the bronchoscope and 2 ml lignocaine 4% within trachea before insertion of endotracheal tube. In Group NB, bilateral superior laryngeal nerves & recurrent laryngeal nerve was blocked. Then a exible breoptic bronchoscope preloaded with a exometallic endotracheal tube of appropriate size was then inserted via nasal route. Results: The mean intubation time for Group NB [87.27 ± 7.58 sec] was shorter than that for Group SA [190.33 ± 9.14] (p<0.0001). Conclusion: Awake exible bronchoscopic intubation under sedation with airway nerve block provides better intubating conditions compared to SAYGO

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