GOLDENHAR SYNDROME-NO MORE A CHALLENGE TO ANAESTHESIOLOGIST

A patient K/C/O Goldenhar syndrome came for right external ear reconstruction. Patient had typical features of the syndrome with hypoplastic mandible and maxillae, malocclusion of teeth ,malaligned teeth ,retrognathia and hypoplastic hyoid bone . Anticipating a difcult intubation it was decided to go ahead with awake intubation in this patient . Blind nasal intubation was planned because of unavailability of breoptic in our institution and it was achieved with 7 mm ivory white north pole tube with dexmedetomidine infusion at rate of 0.5mcg/kg/hr and topical anaesthesia .

Dezocine prevents sufentanil-induced respiratory depression during awake intubation: a multicenter, randomized, controlled study

BackgroundSufentanil has sedative and inhibitory effects on the intubation response, but high doses of sufentanil can cause coughing and respiratory depression. Dezocine has been documented effectively suppressing sufentanil-induced cough. Whether dezocine can inhibit the respiratory depression caused by sufentanil is unknown. This study aims to observe the efficacy of dezocine combined with sufentanil in awake intubation.MethodsFour hundred and three patients of American Society of Anesthesiologists physical status Classes I and II, aged 18–65 years, were randomly allocated into four groups: Group saline (saline + 0.4 ug/kg sufentanil), Group D0.05 (dezocine 0.05 mg/kg + 0.4 ug/kg sufentanil), Group D0.10 (dezocine 0.10 mg/kg + 0.4 ug/kg sufentanil), and Group D0.15 (dezocine 0.15 mg/kg + 0.4 ug/kg sufentanil). The primary outcome of our study was to observe the incidence of respiratory depression. Secondary outcomes included the success rate of intubation, ease of intubation, intubation comfort score, sore throat, hoarseness, lethargy, limb movement, glottis exposing and the satisfaction of patients during intubation. Hemodynamic changes were recorded after sufentanil injection and awake intubation.ResultsThere was no difference in the effect of normal saline and 0.05 mg/kg dezocine on respiratory depression (P = 0.603). The incidence of respiratory depression in Group D0.10 and Group D0.15 was lower than that of Group saline. Cough was statistically different between the four groups (P < 0.05). The incidence of cough in the dezocine groups was lower than that of Group saline. There was a significant difference in patient intubation satisfaction between the four groups (P < 0.05). The satisfaction of patients during intubation were significantly higher in the dezocine groups. Sore throat, hoarseness, lethargy and success rate of intubation were similar between the four groups (all P > 0.05).ConclusionsOur study indicated that 0.10 mg/kg and 0.15 mg/kg dezocine might prevent the occurrence of cough and respiratory depression induced by sufentanil during awake intubation and improve patient satisfaction.Trial registrationClinicaltrials.gov (NCT02673723), 2- 4- 2016.

Improving mucosal anesthesia for awake endotracheal intubation with a novel method: A prospective, assessor-blinded, randomized controlled trial

Background:Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation.Methods:This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed.Results:Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study.Conclusions:In awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.Chinese Clinical Trial Registry: ChiCTR1900023151 ( http://www.chictr.org )

Improving mucosal anesthesia for awake endotracheal intubation with a novel method: a prospective, assessor-blinded, randomized controlled trial

Background Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study. Conclusions In awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray. Trial registration ChiCTR1900023151. Date of registration: May 14th, 2019.

Sufentanil EC50 for Endotracheal Intubation with Aerosol Inhalation of Lidocaine

Background: Nebulized lidocaine combined with opioid drugs was a classical implementation for awake intubation or rigid bronchoscopy. In this study, aerosol inhalation of carbonated lidocaine combined with sufentanil was accomplished prior to induction of anesthesia, to dig out whether the dosage of sufentanil could less or not, and the sufentanil EC50 for endotracheal intubation under these drugs combination.Methods: Intravenous injection of sufentanil starting at 0.5 μg/kg. Then sufentanil dosages were increased/decreased (step-size 0.05 μg/kg for sufentanil) using Dixon and Massey up and down method in the next patient depending upon previous patient's response within 3 min after intubation. The observation was terminated after 8 reflexes. The hemodynamic indexes were recorded.Results: The EC50 and EC95 of sufentanil with aerosol inhalation of lidocaine for endotracheal intubation was found to be 0.232 μg/kg (95% CI: 0.187-0.270 μg/kg) and 0.447 μg/kg (95% CI: 0.364-0.703 μg/kg). 55.88% out of 34 patients showed hemodynamic index change <20% of baseline during endotracheal intubation.Conclusion: Aerosol inhalation of lidocaine could reduce the dosage of sufentanil for endotracheal intubation. The advantages in lidocaine inhalation for airway anesthesia by ultrasonic atomizer could be recommended in patients who need more stable hemodynamic changes.Trial registration: Chinese Registry of Central Trial, ChiCTR-IOR-17014198. Registered 28 December 2017, http://www.chictr.org.cn/showprojen.aspx?proj=22301

Improving mucosal anesthesia for awake endotracheal intubation with a novel method using dyclonine hydrochloride: A prospective, assessor-blinded, randomized controlled trial

Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). Conclusions: In awake endotracheal intubation, novel care using oral dyclonine mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.