Upper Airway Nerve Block for Rigid Bronchoscopy in the Patients with Tracheal Stenosis: A Case Serie

Abstract

<jats:p>Background: Rigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress. Objectives: We introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks. Methods: This prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded. Results: From 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient. Conclusions: The upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.</jats:p>

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

“…Also, it is suggested that video laryngoscopy in comparison to direct laryngoscopy can provide better visualiza-tion for intubation of the trachea in congenital heart disease. However, it needs time and a well-trained expert (64). In children with tongue trauma, a flexible laryngeal mask airway is more appropriate in comparison to the endotracheal tube because it reduces extubation time, recovery period, and hemodynamic changes to the airway control (65).…”

Diagnostic Accuracy of Combined Mallampati and Wilson Score to Predict Difficult Intubation in Obese Patients: A Descriptive Cross-sectional Study

“…Airway assessments are often used, depending on the individual, job scenario, and study method. However, researchers suggested that certain factors be included in airway assessment to predict challenging endotracheal intubation, including Wilson score, BMI, neck circumference (NC) to Thyromental (TM) distance ratio, and ULBT (21)(22)(23). There are numerous tests to predict difficult intubation.…”

Comparison of RAMP and New Modified RAMP Positioning in Laryngoscopic View During Intubation in Patients with Morbid Obesity: A Randomized Clinical Trial

“…Faster decline in arterial oxygen saturation in obese patients, along with the higher prevalence of restrictive lung disease, make such patients less tolerant for delayed intubation; therefore, safer and faster intubation plays a prominent role in airway management of these patients (27). The criteria for the possibility of difficult mask ventilation include history of snoring, obstructive sleep ap- nea, age over 55 years, male sex, beard, BMI over 30 kg/m 2 , and Mallampati 3 or more (28)(29)(30). The possibility of difficult intubation and potential airway management problems must be considered, and preparation should be made for it.…”