fibreoptic intubation
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2021 ◽  
Vol 10 (4) ◽  
pp. e001432
Author(s):  
Wade A Weigel ◽  
Andrew B Lyons ◽  
Justin S Liberman ◽  
C Craig Blackmore

BackgroundAwake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. In our institution, the awake intubation setup process was highly variable and error prone.MethodsWe deployed Lean methods to improve the efficiency and accuracy of the awake fibreoptic intubation setup process. A 2-day improvement event with a multidisciplinary team addressed the setup process, tested solutions and created standard work documents. Twenty awake fibreoptic intubation simulations were conducted before and after the intervention to quantify gains in setup efficiency and error reduction.ResultsVariability in the setup process, including clinical locations visited, was reduced through creating a standardised process. The average time to for an awake fibreoptic intubation setup was reduced by approximately 50%, from 23 min to 11 min (p<0.001). In addition, awake fibreoptic intubation equipment set out without error increased in the postintervention simulations from 59% to 85% (p=0.003).ConclusionUsing Lean tools, we were able to make the setup of awake fibreoptic intubation not only more efficient, but also more accurate. A similar methodological approach may have value for other complex anaesthesia procedures.


2021 ◽  
Vol 12 (11) ◽  
pp. 113-118
Author(s):  
Ritu Baloda ◽  
Jaspreet Kaur ◽  
Rupali Battu ◽  
Sudha Puhal

Background: The hemodynamic changes during awake fibreoptic intubation (AFOI) are attributed to patient’s anxiety, poor topicalization of the airway, excessive sedation, lack of expertise, pain, prolonged time to intubation, stimulation of oropharyngeal structures, and jaw thrust to aid intubation. In this study, we compared hemodynamic changes of dexmedetomidine (DEX) with midazolam (MDZ) and fentanyl during AFOI. Aims and Objectives: The objective of the study is to compare the hemodynamic changes in DEX alone versus fentanyl- MDZ combination during AFOI. Materials and Methods: Group-I patients (n=30) received DEX 1 μg/kg bolus infusion over 10 min, followed by infusion of 0.1 μg/kg/h titrated to 0.7 μg/kg/h whereas Group-II patients (n=30) received iv fentanyl 2 μg/kg bolus followed by MDZ infusion of 0.02–0.1 mg/kg/h until they were adequately sedated, i.e. Ramsay Sedation Score (RSS) of 3. Hemodynamics including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SpO2) were recorded when patient is sedated, i.e. at RSS-3, every min of fibrescopy till 5 min and at intubation and every 3rd min post-intubation till 30 min. Results: Measurements of the HRs in the two groups showed significant differences between the two groups at RSS-3, during FOS and post-intubation with the DEX group showing lower mean HRs compared with the MDZ and fentanyl group. SBP and DBP showed a fall in both the groups as compared with the baseline at RSS-3, during FOS and post-intubation; however, no significant differences were noted between the two groups. The mean SpO2values show significant difference between the two groups. (P<0.05) at RSS-3, FOS, post intubation upto 18 min (P<0.05). Conclusion: The use of DEX at 1 mcg/kg bolus slowly over 10 min, with maintenance rates of 0.1–0.7 μg/kg/h, is safe and beneficial for patients undergoing AFOI. Thus, DEX acts like an ideal drug for AFOI. It provides excellent intubating conditions without significant hemodynamic perturbations and risk of hypoxia.


Author(s):  
Kira J. Tone ◽  
Gian-Marco C. Busato ◽  
Sena Aflaki ◽  
Terence Ip ◽  
Sheldon Lyn

2021 ◽  
Vol 14 (5) ◽  
pp. e242286
Author(s):  
Fathir Fath Mohammad Iskandar ◽  
Nik Amin Sahid Nik Lah ◽  
Abdul Jabbar Ismail ◽  
Tat Boon Yeap

Recurrent laryngeal nerve (RLN) injury is one of the main complications of total thyroidectomy. If the injury is bilateral, total airway obstruction, aphonia and hoarseness of voice could be precipitated. Hence, it is wise for the operating surgeon to be guided by neural monitoring during thyroidectomy. We present a valuable experience handling a middle-aged man with a huge papillary thyroid carcinoma . He needed an urgent thyroidectomy due to obstructive symptoms. We highlight our intraoperative dexterity in handling his surgery in the context of continuous monitoring of RLN using electromyography.


Author(s):  
Ting Li ◽  
Tongtong Liu ◽  
Meihong Li ◽  
Chuanhan Zhang ◽  
Wenlong Yao

2021 ◽  
Vol 38 (3) ◽  
pp. 318-319
Author(s):  
Erik M. Koopman ◽  
Michael W. van Emden ◽  
Jeroen J.G. Geurts ◽  
Lothar A. Schwarte ◽  
Patrick Schober

2021 ◽  
pp. 63-65
Author(s):  
Jaspreet Kaur ◽  
Ritu Baloda ◽  
Anmol Singh Rai

Objectives:To compare the intubating conditions of dexmedetomidine alone versus fentanyl -midazolam combination during AFOI Methodology: Group-I patients (n=30) received dexmedetomidine 1µg/kg bolus infusion over 10 minutes, followed by infusion of 0.1 µg/kg/hr titrated to 0.7 µg/kg/hr whereas Group-II patients (n=30) received i.v fentanyl 2µg/kg bolus followed by midazolam infusion of 0.02-0.1mg/kg/hr until they were adequately sedated i.e. Ramsay Sedation Score (RSS) of 3 .Intraoperatively Total Comfort Score, 5 point FOI score was noted and Questionnaire assessment was done 24 hours after surgery. Results: During preoxygenation, the mean TCS was not statistically signicant different between the two groups but during FOS and during intubation, the mean TCS was lower in group-1than group-2and the difference between the two groups was statistically signicant.(p<0.05). Signicant differences in the patient's reaction to tube were found during FOS and after intubation between the two groups with lower reaction in dexmedetomidine group(p≤0.05). During follow-up assessment 24 hours after the surgical procedure, the dexmedetomidine group patients judged their sedation more positively and were having less pain and discomfort during the procedure than fentanyl plus midazolam patients. Conclusion: The use of dexmedetomidine at 1mcg/kg bolus over 10 minutes, with maintenance rates of 0.1-0.7 μg/kg/hr offer better tolerance, preservation of a patent airway and spontaneous ventilation, while maintaining hemodynamic stability during AFOI.


2021 ◽  
Vol 14 (2) ◽  
pp. e238600
Author(s):  
Ming Kai Teah ◽  
Esther Huey Ring Liew ◽  
Melvin Teck Fui Wong ◽  
Tat Boon Yeap

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.


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