A non-tracheal intubation (tubeless) anesthetic technique with spontaneous respiration for upper airway surgery

Xu, Jing; Yao, Zheng; Li, Shaoqing; Chen, Lianhua

doi:10.25011/cim.v36i3.19726

Cited by 16 publications

(19 citation statements)

References 18 publications

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“…The nine included studies on opioids reported that fentanyl depresses upper airway reflexes, and that sufentanil, alfentanil, remifentanil, and fentanyl are all associated with perioperative upper airway obstruction (Table ) . Tagaito et al and Goyagi et al both reported that fentanyl depresses upper airway reflex responses .…”

Section: Resultsmentioning

confidence: 99%

The effects of Anesthesia and opioids on the upper airway: A systematic review

Mahmoud²,

et al. 2015

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Section: Resultsmentioning

confidence: 99%

The effects of Anesthesia and opioids on the upper airway: A systematic review

Mahmoud²,

et al. 2015

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“…The properties of rapid onset and offset of action and of smooth recovery (6) make propofol an appealing agent alone or in combination with an opioid for procedural sedation (7)(8)(9)(10). However, dose-dependent respiratory depression and hypoxemia are possible, owing to interactions and synergism between sedatives and opioids (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study

Yuan

Yang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the effect of a combination of dexmedetomidine and fentanyl on peripheral oxygen saturation (SpO 2 ) and hemodynamic stability in patients undergoing flexible bronchoscopy. One hundred patients undergoing elective flexible bronchoscopy were randomized into either a propofol-fentanyl group (PF group; n=50) or a dexmedetomidine-fentanyl group (DF group; n=50). SpO 2 values, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), patients' cough scores and discomfort scores as determined by patients and bronchoscopists, levels of sedation, number of times that additional lidocaine was required, elapsed time until recovery, and adverse events were recorded. The mean SpO 2 values in the DF group were significantly higher than those in the PF group (P<0.01), and HR, SBP and DBP were significantly lower in the DF group than in the PF group (P<0.05). There were no statistically significant differences between the two groups in terms of cough scores or discomfort scores, sedation levels, or number of times that additional lidocaine was required (P>0.05). Elapsed time until recovery in the DF group was significantly longer than in the PF group (P=0.002). The incidence of hypoxemia was significantly lower in the DF group than in the PF group (P= 0.027), but the incidence of bradycardia was significantly higher in the DF group than in the PF group (P= 0.037). Dexmedetomidine-fentanyl was superior to propofol-fentanyl in providing satisfactory SpO 2 . Furthermore, dexmedetomidine-fentanyl attenuated hemodynamic responses during bronchoscopy and maintained hemodynamic stability in the early stage of the procedure. IntroductionFlexible bronchoscopy is commonly used for the diagnosis and management of a variety of pulmonary diseases. However, it is an invasive procedure that can induce coughing, pain, dyspnea and other adverse effects (1,2). The use of sedatives not only can increase patients' safety and comfort (3) but also can make it easier for the bronchoscopist to perform the procedure and thus avoid extending its duration (4). In addition to alleviating the physiological response to airway irritation during the procedure (5), the proper sedatives should have a rapid onset and a short duration of action, in addition to allowing rapid recovery.Propofol, a non-opioid and nonbarbiturate sedative hypnotic agent, is frequently used in the induction and maintenance of anesthesia. The properties of rapid onset and offset of action and of smooth recovery (6) make propofol an appealing agent alone or in combination with an opioid for procedural sedation (7-10). However, dose-dependent respiratory depression and hypoxemia are possible, owing to interactions and synergism between sedatives and opioids (11-13).Dexmedetomidine, a highly selective α 2 -adrenoceptor agonist, has an affinity for α 2 -adrenoceptors that is 8-fold greater than that of clonidine (14). In addition to providing sedative and analgesic effects (15), dexmedetomidine can be applied generally duri...

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“…Apneic anesthesia (with intermittent ventilation) and spontaneous ventilation anesthesia are used frequently in laryngeal surgeries, especially in short cases . They provide an excellent surgical view and eliminate the risk of igniting the endotracheal tube with a laser.…”

Section: Discussionmentioning

confidence: 99%

“…This can better maintain the lung oxygen partial pressure than nasal prongs that provide a much lower effective inspired oxygen concentration . Unlike prior studies, we not only use this technique for airway procedures but also for other laryngeal surgeries that do not last for more than an hour . The use of high‐flow oxygen allows the passive diffusion of oxygen into the lungs and does not create positive pressure, eliminating the risk of barotrauma as long as the airway is open.…”

Section: Discussionmentioning

confidence: 99%

“…Apneic ventilation is a widely used technique in laryngology practice, as it provides an unobstructed surgical view of the vocal folds while eliminating the risk of igniting the endotracheal tube when using a laser or cautery. However, with this technique, the surgeon is frequently interrupted to ventilate the patient, and the larynx is potentially exposed to repetitive trauma due to passage of the endotracheal tube …”

Section: Introductionmentioning

confidence: 99%

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