ABSTRACT
Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.
Subject(s)
Airway Obstruction/therapy , Intubation, Intratracheal , Laryngeal Nerves , Nerve Block , Airway Obstruction/surgery , Anesthesia, Local , Constriction, Pathologic , Female , Fiber Optic Technology/methods , Humans , Intubation, Intratracheal/methods , Lidocaine , Male , Middle Aged , WakefulnessABSTRACT
In obese patients with unfavorable airways, awake fiberoptic intubations are sometimes performed to maintain spontaneous respiration and airway reflexes, until a secure airway is attained. Obese patients may be sensitive to the effects of sedation. Rapid oxygen desaturation may occur as a result of brief moments of apnea from even minimal amounts of sedating medications, due to poor baseline functional reserve as well as common comorbid conditions such as obstructive sleep apnea and obesity hypoventilation syndrome. To maximize the chance of success when performing an awake fiberoptic intubation in a minimally sedated patient, the upper airway should be sufficiently anesthetized. Adequate topical anesthesia minimizes airway stimulation, optimizes patient comfort and facilitates patient compliance. We report two cases of awake fiberoptic intubation in two morbidly obese patients, where a simple apparatus, made of an atomizer embedded in an oral airway, was used to effectively topicalize the airway and achieve excellent intubating condition with minimal sedation.
Subject(s)
Fiber Optic Technology , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Obesity, Morbid/complications , Wakefulness , Adult , Anesthesia, Local , Conscious Sedation , Debridement , Herniorrhaphy , Humans , Male , Middle Aged , Necrosis/surgery , Obesity Hypoventilation Syndrome/prevention & control , Vasculitis/chemically induced , Vasculitis/surgeryABSTRACT
There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope(R) Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists.