Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Awake fiberoptic nasotracheal intubation for patients with difficult airway

  • Tsukamoto, Masanori (Department of Dental Anesthesiology, Kyushu University Hospital) ;
  • Hitosugi, Takashi (Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University) ;
  • Yokoyama, Takeshi (Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University)
  • Received : 2018.07.07
  • Accepted : 2018.09.11
  • Published : 2018.10.31
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Abstract

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

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References

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  1. Dexmedetomidine in the Management of Awake Fiberoptic Intubation vol.13, pp.None, 2018, https://doi.org/10.2174/2589645801913010001