Anesthesia, Intubation, Trachea
Conditions
Keywords
Awake fiberoptic intubation
Brief summary
Awake fibreoptic intubation (AFOI) is a classic and standard method for some special patients which is also difficult for anesthesiologists to learn and master. The procedure is sometimes hard and often takes about 20-30 min. Most of patients have a strong sense of discomfort. Investigators conducted the research to study the simplification and feasibility of AFOI.
Detailed description
Many studies have studied the sedative drugs and regional anesthesia related to awake intubation. However, several problems of AFOI are existing including long operation time, patients' strong discomfort, coughing and resistance. And, to investigators' knowledge, there was a lack of a fixed procedure for the implementation of AFOI. Investigators conducted the research and aimed to study the simplification and feasibility of a new AFOI method based on years of clinical theory, practice and experience.
Interventions
PROCEDUREAwake fiberoptic intubation (AFOI)
With forty patients (ASA I\ II, aged 18\ 75, simulating cervical instability injury) recruited to be operated on under general anesthesia, two experienced anesthesiologists performed the whole procedures within the study. Pre anesthetic interview was taken to illustrate the procedures of tracheal intubation to the patients. The simplified method consisted of three parts: conscious sedation, regional anesthesia and intubation. The time of AFOI, rate of one-time intubation success, hemodynamic parameters, pulse oxygen saturation (SpO2), rate of amnesia of the intubation, patients' satisfaction, and relative complications were recorded accordingly.
Sponsors
Fudan University
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. American Society of Anesthesiologists' physical status I-II patients 2. Aged 18-75 years 3. Mallampati Grade I-II 4. Body Mass Index 18.5-28 kg·m-2
Exclusion criteria
1. Allergic to the drugs involved in the study 2. Neck mass or infection 3. Drug or alcohol abuse 4. Pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The average total time of Awake Fiberoptic Orotracheal Intubation (AFOI) | End of the AFOI | The time from the midazolam injection to positive end tidal CO2 acquired (Minutes) |
| The rate of one-time intubation success. | End of the AFOI | All steps are successful once (Percentage) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate, HR (bpm) | During the AFOI | HR is used to assess hemodynamic fluctuations |
| Rate of amnesia of the intubation | On the first postoperative day | It is used to assess anterograde amnesia of midazolam |
| Ramsay sedation scale | During the AFOI | 1= anxious or restless or both, 2 = cooperative, orientated and tranquil, 3 = responding to commands, 4 = brisk response to stimulus, 5 = sluggish response to stimulus, 6= No response to stimulus |
| Patients' satisfaction | On the first postoperative day | 1 = excellent, 2 = good, 3 = fair, 4 = poor |
| Systolic blood pressure, SBP (mmHg) | During the AFOI | SBP is used to assess hemodynamic fluctuations |
| Relative complications | End of the surgery and the first postoperative day | Such as arrhythmias, bleeding or sore throat |
| Vocal cord movement | During the AFOI | 1 = open, 2 = moving, 3 = closing, 4 = closed |
| Hypoxic episode | During the AFOI | SpO2\<90% |
| Unexpected coughing | During the AFOI | Unexpected coughing was evaluated with 4 score (1=none, 2\< 3 times unexpected slight coughing comparable to 'clearing ones' throat', 3≥2 times, mild unexpected coughing lasting less than a minute, 4=persistent unexpected coughing) |
| Diastolic blood pressure, DBP (mmHg) | During the AFOI | DBP is used to assess hemodynamic fluctuations |
Countries
China
Outcome results
None listed