Awake Fiberoptic Intubation, Difficult Airway, Sedation, Sevoflurane
Conditions
Brief summary
The aim of this study is to compare patient satisfaction and intubating conditions with fiber optic intubation under sevoflurane sedation versus airway blocks in difficult airway patients
Detailed description
Awake fiberoptic intubation (AFOI) is a suitable option for anticipated difficult intubation. The ideal condition for AFOI requires a calm, cooperative patient with blunted airway reflexes to facilitate easy intubation, especially if there is difficulty with laryngeal anatomy and/or pathology. For this purpose, sedative and anxiolytic agents such as benzodiazepines, sevoflurane, remifentanil, ketamine, propofol, and dexmedetomidine are almost always required to relieve the patients from comfort without impairing ventilation. Patient responsiveness and cooperation are almost always required.
Interventions
DRUGSevoflurane
Patients will undergo fiberoptic intubation under sevoflurane sedation.
DRUG2% Xylocaine (2 ml )
Patients will undergo fiberoptic intubation with bilateral Superior Laryngeal Nerve block and Recurrent laryngeal nerve block.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 50 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Patients with difficult airway (Mallampati grade 3 and 4 with mouth opening less than 5 cm).
Exclusion criteria
* Patient refusal. * Patients with bleeding disorders and nasal mass. * Allergy or intolerance to one of the study medications. * Patients with uncontrolled systemic diseases. * patients with gastro-esophageal reflex. * history of nasopharyngeal surgery or drug abuse.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Degree of patient satisfaction | Immediately after intubation | The degree of patient satisfaction will be assessed on a 4-point Likert scale patient satisfaction (1, very dissatisfied; 2, unsatisfied; 3, satisfied; 4, very satisfied). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intubation time | Intraoperatively | Intubation time (time from insertion of the fiberoptic bronchoscope throughout the nose till confirmation of intubation with capnography) |
| Heart rate | 5 minutes after intubation | Heart rate will be recorded on arrival to the operating room as a baseline, immediately prior to fiberoptic intubation, at the time of intubation and then at 1, 3, and 5 minutes after intubation. |
| Mean arterial pressure | 5 minutes after intubation | Mean arterial pressure will be recorded on arrival to the operating room as a baseline, immediately prior to fiberoptic intubation, at the time of intubation and then at 1, 3, and 5 minutes after intubation. |
| Patient's tolerance to endoscopy | Intraoperatively | The patient's reaction to the placement of the fiberoptic scope will be assessed on a scale of 1 to 5 and will be recorded (1, no reaction; 2, slight grimacing; 3, severe grimacing; 4, verbal objection; 5, defensive movement of head, hands, or feet). |
| Patient's tolerance to intubation | Intraoperatively | The patient's reaction to the placement of the endotracheal tube will be assessed on a scale of 1 to 5 and was recorded (1, no reaction; 2, slight grimacing; 3, severe grimacing; 4, verbal objection; 5, defensive movement of head, hands, or feet) |
Countries
Egypt
Contacts
Primary ContactMarwa A Abogabal, MD
Outcome results
None listed