J Dent Anesth Pain Med.  2018 Oct;18(5):301-304. 10.17245/jdapm.2018.18.5.301.

Awake fiberoptic nasotracheal intubation for patients with difficult airway

• Tsukamoto
• Hitosugi T
• Yokoyama T

• KMID: 2424371
• DOI: http://doi.org/10.17245/jdapm.2018.18.5.301

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 µg of fentanyl 2-3 times (total 2.2-2.3 µg/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.

Keyword

Conscious Sedation; Fiberoptic Nasotracheal Intubation; Topical Anesthesia

MeSH Terms

Airway Obstruction
Anesthesia
Conscious Sedation
Epiglottis
Fentanyl
Humans
Intubation*
Male
Masks
Methods
Midazolam
Nasal Cavity
Oxygen
Respiration
Surgery, Oral
Trachea
Vocal Cords
Fentanyl
Midazolam
Oxygen

Figure

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  Fig. 1 Reasons for conscious sedation. (A) Left lower fibrous tumor, (B) Postoperative infection after the patient underwent mandibular resection and reconstruction with a metal instrument for left mandibular gingiva.

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