Efficacy of ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intubation / 临床麻醉学杂志

Objective To observe the efficacy of the ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intubation.Methods Forty patients with limited cervical activity scheduled for elective surgery under general anesthesia,23 males and 17 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were chosen.According to random number table method,they were randomly divided into two groups (n =20).Group N received superior laryngeal nerve block u-sing the acupoint-located method by anatomical landmark,and group D was under ultrasound-guided, combined with airway anesthesia.Awake orotracheal fiberoptic intubation was then performed.Intu-bation time and the changes of MAP,HR,Ramsay sedation score were recorded at the time of bur-glary (T0 ),before the endotracheal tube into the mouth (T1 ),endotracheal tube into the glottis im-mediately (T2 ),5 min after intubation (T3 ).Ramsay score was rated to assess the patients'comfort and tolerance,complications during intubation process were documented,the patient's satisfaction was received.Results Compared with the group N,the intubation time of group D was significantly shorter [(0.5±0.1)min vs (1.0±0.2)min,P <0.05].In group N,MAP and HR were obviously higher during intubation with lower Ramsay sedation score at T2 compared with group D (P <0.05). Patients in group D had lower comfort score and tolerance grade during intubation (P <0.05).The incidence of nausea,vomiting,restlessness and pharyngalgia were significantly lower in group D (P< 0.05 ).Besides, patients during intubation in group D were more satisfactory (P < 0.05 ). Conclusion Ultrasound-guided superior laryngeal nerve block for awake orotracheal fiberoptic intuba-tion could provide an ideal sedative effect,maintain stable circulation and keep patients tolerable.

A randomised comparative study of dexmedetomidine and midazolam for sedation during awake fiberoptic intubation in laproscopic cholecystectomy patients.

Fiberoptic nasotracheal intubation is an effective method for the management of patients with difficult airways. An ideal sedation regimen would ensure patient’s comfort, attenuation of airway reflexes, patient’s co-ordination, haemodynamic stability and amnesia. It is critical for both the surgeon and the anesthesiologist to understand the physiologic consequences of laparoscopy and to work in cooperation to achieve a good surgical outcome. Methods: Patients were randomly allocated to midazolam (MDZ) group (group 1) and dexmedetomidine (DEX) group (group 2). DEX patients received dexmedetomidine 1μg/kg, followed by an infusion of dexmedetomidine 0.1μg/kg/hr titrated to 0.7μg/kg/hr to achieve RSS ≥2. MDZ subjects received IV midazolam 0.05mg/kg with additional doses given to achieve a RSS ≥ 2. Measurements: Pulse rate, systolic and diastolic blood pressures and SpO2 recorded during pre-oxygenation, one minute prior to introduction of fiberscope and then every minute for the following five minutes and beginning one minute before endotracheal intubation and then every minute until the endotracheal tube was secured, patient’s tolerance assessed on 5 point fiberoptic intubation score during fiberscopy and endotracheal intubation, total comfort score values assessed during pre-oxygenation, fiberscopy and endotracheal intubation and patient’s response to 24 hour post op questionnaire assessment were measured. Results: DEX group patients were significantly more quiet and more harmonius during awake fiberoptic intubation (AFOI) than were the MDZ group patients. The DEX group patients were found to have a lower mean Heart Rate than the MDZ patients. Conclusions: Both dexmedetomidine and midazolam are effective for fibreoptic intubation. Dexmedetomidine allows better endurance, stable haemodynamic status and a patent airway.

Anesthetic management for a patient with severe mento-sternal contracture: difficult airway and scarce venous access: A case report / 대한마취과학회지

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.

Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed: A case report / 대한마취과학회지

Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.