J Dent Anesth Pain Med.  2018 Oct;18(5):301-304. 10.17245/jdapm.2018.18.5.301.

Awake fiberoptic nasotracheal intubation for patients with difficult airway

Affiliations
  • 1Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan. tsukamoto@dent.kyushu-u.ac.jp
  • 2Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.

Abstract

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received 50 µg of fentanyl 2-3 times (total 2.2-2.3 µg/kg) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

Keyword

Conscious Sedation; Fiberoptic Nasotracheal Intubation; Topical Anesthesia

MeSH Terms

Airway Obstruction
Anesthesia
Conscious Sedation
Epiglottis
Fentanyl
Humans
Intubation*
Male
Masks
Methods
Midazolam
Nasal Cavity
Oxygen
Respiration
Surgery, Oral
Trachea
Vocal Cords
Fentanyl
Midazolam
Oxygen

Figure

  • Fig. 1 Reasons for conscious sedation. (A) Left lower fibrous tumor, (B) Postoperative infection after the patient underwent mandibular resection and reconstruction with a metal instrument for left mandibular gingiva.


Reference

1. Prasanna D, Bhat S. Nasotracheal Intubation: An Overview. J Maxillofac Oral Surg. 2014; 13:366–372.
Article
2. Dhasmana S, Singh V, Pal US. Awake Blind Nasotracheal Intubation in Temporomandibular Joint Ankylosis Patients under Conscious Sedation Using Fentanyl and Midazolam. J Maxillofac Oral Surg. 2010; 9:377–381.
Article
3. El-Boghdadly K, Onwochei DN, Cuddihy J, Ahmad I. A prospective cohort study of awake fibreoptic intubation practice at a tertiary centre. Anaesthesia. 2017; 72:694–703.
Article
4. Xue FS, Liu HP, He N, Xu YC, Yang QY, Liao X, et al. Spray-as-you-go airway topical anesthesia in patients with a difficult airway: a randomized, double-blind comparison of 2% and 4% lidocaine. Anesth Analg. 2009; 108:536–543.
Article
5. Shen SL, Xie YH, Wang WY, Hu SF, Zhang YL. Comparison of dexmedetomidine and sufentanil for conscious sedation in patients undergoing awake fibreoptic nasotracheal intubation: a prospective, randomised and controlled clinical trial. Clin Respir J. 2014; 8:100–107.
Article
6. Johnston KD, Rai MR. Conscious sedation for awake fibreoptic intubation: a review of the literature. Can J Anaesth. 2013; 60:584–599.
Article
7. Tsukamoto M, Hirokawa J, Yokoyama T. Airway spray efficacy of local anesthetic with fiberscope. J Anesth. 2017; 31:639.
Article
8. Kumar P, Kaur T, Atwal GK, Bhupal JS, Basra AK. Comparison of Intubating Conditions using Fentanyl plus Propofol Versus Fentanyl plus Midazolam during Fiberoptic Laryngoscopy. J Clin Diagn Res. 2017; 11:21–24.
Article
9. Barends CR, Absalom A, van Minnen B, Vissink A, Visser A. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety. PLoS One. 2017; 12:e0169525.
Article
10. Dhasmana S, Singh V, Pal US. Awake blind nasotracheal intubation in temporomandibular joint ankylosis patients under conscious sedation using fentanyl and midazolam. J Maxillofac Oral Surg. 2010; 9:377–381.
Article
Full Text Links
  • JDAPM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr