Abstract :
Background: Securing airway in patients with large goiter and distorted tracheal anatomy is one of the most challenging clinical scenario for anesthesiologists. Improved glottic visualization with video-laryngoscope and fibreoptic bronchoscope help in successful endotracheal intubation in such cases. Use of these gadgets requires specialized anesthetic technique which allows patient to tolerate airway instrumentation without supressing their own respiration. Authors describe use of a novel device which allows continuous delivery of oxygen and inhaled anesthetics throughout fibreoptic intubation.
Materials and Methods: This prospective pilot study was conducted in a tertiary care center following ethics committee approval. Ten patients (N=10) with a predicted difficult intubation score greater than 5 were included after obtaining written informed consent. Patients were sedated using an inhalational induction technique with sevoflurane while preserving spontaneous breathing. The time required to visualize the glottic opening and carina, as well as the time for intubation with the endotracheal tube and the display of the end-tidal CO2 (EtCO) graph on the monitor, were recorded.
Results: Results showed that all ten patients remained hemodynamically stable throughout the procedure. The mean end-tidal sevoflurane concentrations at induction and intubation were 5.6±0.14% and 5.3±0.15%, respectively. The average times for glottic view, carinal view, intubation, and EtCO2 detection were 77.9±39.9 seconds, 163.1±54 seconds, 229.6±51.7 seconds, and 267.8±56.2 seconds, respectively.
Conclusion: This novel device facilitates the continuous delivery of oxygen and inhaled anesthetics without leak, thanks to its one-way valve, throughout fiberoptic bronchoscopy (FOB)-guided intubation. Given that our study with a sample size of 10 reported no adverse events, it suggests that this device can be safely incorporated into anesthesia breathing circuits.
Keyword :
Awake orotracheal intubation, Fiberoptic- bronchoscope, Difficult airway, Goiter, Airway management.