Awake fiberoptic nasotracheal intubation for patients with difficult airway

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.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

Effective removal of epistaxis during nasotracheal intubation utilizing a fiberoptic scope in a difficult airway: A case report / 대한마취과학회지

Nasal bleeding related to nasal trauma is the most common complication of nasotracheal intubation with a fiberoptic scope. When nasotracheal intubation with a fiberoptic scope is performed, profuse bleeding from the nasal cavity makes it difficult to handle a fiberoptic scope and may cause a hypoxemia. So when nasal bleeding occurs, it is important to suction the nasal cavity for easy handling of a fiberoptic scope. But, it may be difficult to suction in a nasal cavity with a fiberoptic suction port only. We report a patient with nasal bleeding following nasotracheal intubation with a fiberoptic scope because of articular trismus, and successful nasotracheal intubation utilizing a fiberoptic scope by suctioning with an extra suction apparatus.

The Chanages of Blood Pressure , Heart Rate and Cardiac Output During Awake Fiberoptic Nasotracheal and Orotracheal Intubation / 대한마취과학회지

To evaluate the clinical usefulness of fiberoptic intubation, we recorded the changes of arterial pressure, heart rate and cardiac output during fiberoptic nasotracheal and orotracheal intubation, while measuring the time taken for the intubation procedure. Anesthesia of pharynx was achieved by oral gargling of 10 ml of 4% lidocaine, and for nasotracheal intubation, nasal mucosa was anesthetized by application of 4% cocaine usirig cotton-tipped swabs. Anesthesia of the larynx and trachea was done by superior laryngeal nerve block with 6 ml of 2% lidocaine, and translaryngeal injection with 4% lidocaine by cricothyroid membrane puncture. After sedation with intravenous diazepam and fentanyl, awake fiberoptic (n=32) or orotracheal intubation (n=18) was performed on the patients (ASA class 1 or 2) in whom difficult intubation was expected. Mean arterial pressure, heart rate and cardiac output did not change significantly during intubation procedure, nor were these values significantly different between nasotracheal and orotracheal intubation group. The time taken by intubation procedure were compared, and there was no significant difference between two groups. In postoperative interviews, a few (3/28) patients complained discom-forts. It could be concluded that under approapriate anesthesia and sedation, awake fiberoptic nasotracheal or orotracheal intubation is a safe and useful approach producing minimal cardiovascular changes and discomforts.