Awake Blind Nasotracheal Intubation in Temporomandibular Joint Ankylosis Patients under Conscious Sedation Using Fentanyl and Midazolam (original) (raw)
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Saudi Journal of Anaesthesia, 2012
background: Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. this study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. they were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups-group d and group P, of 23 patients each. group d patients had received premedication of dexmedetomidine 1 µg/kg infused over 10 min followed by sedative propofol infusion and the control group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. results: The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. conclusion: Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.
IP innovative publication pvt. ltd, 2019
Introduction: Awake fiberoptic intubation (AFOI) under sedation and local anaesthesia is gold standard in anticipated difficult airway scenarios. Various drugs are used to achieve conscious sedation with adequate analgesia such as propofol, fentanyl, nalbuphine and midazolam. In this study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing AFOI using spray as you go method. Materials and Methods: 60 patients between the age of 18 and 60yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score. Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F. Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.
Medical Biological Science and Engineering
Temporomandibular joint ankylosis is a rare disease that characterized by mouth opening limitation, which causes problems with basic functions such as eating and breathing as well as anesthetic problems such as facial dysmorphism. Surgical treatment is essential to correct these disorders, but airway management during general anesthesia can be very challenging because difficult ventilation and intubation are anticipated. Fibroptic nasotracheal intubation is the gold standard, and it is important to plan and implement which nostril to access when actually doing it. We are presenting a case of a patient who successfully and safely underwent fibroptic bronchoscopy according to the intubation plan which supported by pre-operative CT and fibroptic laryngoscopy.
Introduction: Temporomandibular joint (TMJ) ankylosisis acondition associated with limited to zero mouth opening. In addition to facial asymmetry, malocclusion, anemia& malnutrition, airway obstruction may be present. All these changes make not only intubation but ventilation also difficult. Method: In this article we wantto report anaesthetic management of 31 patients having temporomandibular joint ankylosis by using blind nasal intubation technique. In all patients mouth opening is either zero or less than 5mm. Observation: In 87.09% patients we could intubate by blind nasotracheal intubation technique while 13.91% patients required tracheostomy.
IP Innovative Publication Pvt. Ltd., 2019
Introduction: In patients with anticipated difficult airway, awake fiber optic intubation (AFOI) is an established modality. Various drugs have been used to provide favourable intubating conditions with good patient comfort and cooperation. Commonly used agents are opioids and benzodiazepines along with the recent agents like dexmedetomidine. We undertook this study to compare dexmedetomidine against propofol-fentanyl combination for AFOI. Materials and Methods: A randomized prospective study was performed on sixty patients with anticipated difficult airway and allocated into two groups each containing thirty. Propofol-fentanyl (PF) group received initial bolus of inj propofol 0.5 mg/kg and fentanyl 0.5?g/kg followed by propofol infusion of 30µg/kg/min and dexmedetomidine (DEX) group received loading dose of 1µg/kg for 10 min and followed by maintenance infusion of 0.5?g/kg/h. We analyzed haemodynamics, saturation, Ramsay sedation score, rescue midazolam requirement, airway obstruction, patient tolerance and intubating conditions. Results: There was no difference in demographic variables between the two groups. PF group achieved higher mean Ramsay sedation score (RSS) during AFOI as compared to DEX group, (P<0>?2) as compared to DEX group (40%) (p<0> Twenty-three (76.7%) in DEX group had patent airway (score 1) compared to twelve patients (40%) in PF group (P<0> Conclusion: Both PF and DEX provided comparable satisfactory intubating conditions for AFOI in terms of vocal cord and limb movement scores. However, PF combination provided lower cough scores and better patient tolerance scores. Dexmedetomidine offered better patent airway with spontaneous ventilation. Reduced hemodynamic response to intubation was achieved in both the groups, although PF group caused more hypotension during AFOI. No episodes of hypoxia was seen in both the groups. Keywords: Difficult airway, Awake fiberoptic intubation, Propofol-fentanyl, Dexmedetomidine infusion.
Journal of Evolution of medical and Dental Sciences, 2015
BACKGROUND: The standard techniques of tracheal intubation are usually done after induction of anaesthesia followed by skeletal muscle relaxation. The muscle relaxants are associated with many side effects. These side effects have spurred research into development of alternative methods for providing good intubating conditions. AIMS AND OBJECTIVES: Present study is designed to compare the intubating conditions, hemodynamic changes following two different doses of fentanyl (2 and 3mcg/kg) using midazolam, lignocaine and propofol induction. MATERIALS AND METHOD: A prospective randomized study was carried out in the department of Anaesthesia at Rajarajeswari Medical College and Hospital. The patients of either sex and age group between 18 and 60years belonging to ASA I and II scheduled for operation under general anaesthesia in various surgical departments for elective surgery were subjects of our study. Patients were randomly divided into two groups of 50 patients each. Group-I received Midazolam (0.04mg/kg), study drug Fentanyl (2mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). Group-II received Midazolam (0.04mg/kg), study drug Fentanyl (3mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). STATISTICAL ANALYSIS: To assess the intubating conditions Statistical test used was chi square test and software used was SPSS version 10. The power we achieved for response to intubation is 0.95. To assess the hemodynamic effects Statistical test used was paired t test within the group and student t test between the groups and software used was SPSS version 10. The power we achieved for pulse rate and mean BP is 0.81 and 0.93 respectively. RESULTS AND CONCLUSION: showed that fentanyl 3mcg/kg with propofol, midazolam and lignocaine provides better intubating conditions and effective in blunting hemodynamic responses to intubation when compared to fentanyl 2mcg/kg. Fentanyl 3mcg/kg with propofol, midazolam and lignocaine combination represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.
Awake fiber optic intubation (AFOI) is the gold standard technique for management of anticipated or recognised difficult airway. Inspite of availability of several sedatives and analgesics, at higher doses these drugs cause respiratory depression and obtundation of sensorium. The present study was conducted to evaluate and compare the efficacy of Dexmedetomidine or Fentanyl – Midazolam combination for sedation during AFOI. Sixty patients of ASA physical status I & II, aged > 18 years undergoing AFOI were made into different groups and administered with Dexmedetomidine (Group-D, 1 mcg/kg over 10 minutes) or Fentanyl-Midazolam (Group-FM, 1 µg/kg and 1mg respectively). The demographic data, patient comfort score and post-intubation score were compared between two groups. Results from the study indicate that the Fiberoscopy was easy in all patients except in three patients in Group-FM, while intubation was easy in all patients except five patients in Group-FM. Hemodynamic responses were comparable between groups except significant change in respiratory rate and oxygen saturation in Group-FM before and after intubation. No serious adverse events in any of the subjects was observed during the study. Thus, we can conclude from the present study that Dexmedetomidine provides safe and better intubating condition for patients undergoing AFOI, without adversely affecting airway and hemodynamic stability.
The Kaohsiung Journal of Medical Sciences, 2010
Muscle relaxants are frequently used to facilitate endotracheal intubation during the induction of anesthesia . However, the administration of short-acting depolarizing muscle relaxants is associated with postoperative myalgias, malignant hyperthermia, hyperkalemia and increased intracranial or intraocular The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 μg/kg dexmedetomidine (Group D, n = 30) or 2 μg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.
Journal of Maxillofacial and Oral Surgery, 2014
Study Design This randomized, comparative clinical study was designed to compare 2 % lignocaine nebulization and 2 % lignocaine via spray-as-you-go technique for topical airway anaesthesia during or awake flexible fiberoptic intubation (AFOI) in temporomandibular joint (TMJ) ankylosis patients. Methods Sixty adult patients with TMJ ankylosis were randomly assigned to the following study groups using a computer generated random number table 2 % lignocaine nebulised (group A) and 2 % lignocaine via spray-as-yougo technique (group B). After airway anaesthesia, awake flexible fiberoptic nasotracheal intubation was performed. An independent investigator who did not participate in the study scored patients' comfort during airway topical anaesthesia and patients' reaction during awake FOI. Changes in haemodynamics during the airway manipulation were also observed. Results There were no statistically significant differences in the observed variables between the two groups. Conclusions Both 2 % lignocaine nebulization and 2 % lignocaine spray-as-you-go technique provided acceptable conditions for AFOI in TMJ patients.