Conscious sedation for awake fibreoptic intubation: a review of the literature

Johnston, Kevin; Mridula, R.

doi:10.1007/s12630-013-9915-9

Cited by 107 publications

(86 citation statements)

References 71 publications

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“…A recent literature review on fiberoptic bronchoscopy drugs concluded that there is good evidence supporting the use of one of the two drugs in procedures such as the present case, one of these being remifentanil 7. A randomised controlled trial looked at the effectiveness of remifentanil versus fentanyl and midazolam in 74 patients; patients treated with remifentanil tolerated the procedures better with a large majority experiencing no cough 8.…”

Section: Discussionmentioning

confidence: 73%

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Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic

et al. 2015

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We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.

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Section: Discussionmentioning

confidence: 73%

“…The ‘spray as you go’ technique would normally be used in cases where you were using a fiberoptic bronchoscope as this aids the remifentanil use 7. It is noted that introducing this form of spray is difficult to achieve in patients with critical obstruction 9.…”

Section: Discussionmentioning

confidence: 99%

Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic

et al. 2015

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“…However, DMV is underestimated by most anesthesiologists. DMV may occur before intubation or after failure of endotracheal intubation [6]. All anesthesiologists should therefore have knowledge of DMV, causes of DMV and alternative techniques when mask ventilation has become difficult or has failed [7].…”

Section: Discussionmentioning

confidence: 99%

Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

Baral¹,

Ide²,

Uzawa³

et al. 2015

OJAnes

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Since maxillofacial malignancy is a common cause of facial defects and disfigurement of the face that may make fitting of a mask difficult and cause air leakage from the side, thus making mask ventilation difficult. In addition, distorted anatomy of the airway and base of the skull in such patients may cause difficult intubation (DI). We experienced a case with a huge facial defect due to maxillary carcinoma, in which difficult mask ventilation (DMV) and DI were predicted. After evaluation by three-dimensional airway computed tomography, the airway was secured with conscious sedation using dexmedetomidine, and awake fiberoptic intubation was safely performed. Three-dimensional airway computed tomography seems to be a good tool for successful intubation when DMV and DI are predicted.

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“…Dexmedetomidine is a selective alpha-2 agonist, and can cause sedation without significant respiratory depression and hypoxia [43,44]. It has more haemodynamic stability than other agents; however, one study showed 65% post-induction hypotension [45].…”

Section: Sedationmentioning

confidence: 99%