Awake fibre optic intubation for difficult airway at high altitude of 12000 feet above mean sea level

Abstract

Awake fibre optic naso-tracheal intubation is a gold standard technique expedient in patients planned for maxillofacial surgeries with known difficult airways. The technique not only provides adequate depth of anaesthesia to secure the airway, it also facilitates maintenance of the spontaneous breathing by the patient. While managing a known difficult airway at high altitude maintaining the spontaneous breathing of the patient becomes all the more important due to the decrease in the partial pressure of the oxygen in the ambient air leading to early desaturation of the patient. In the present case infusion of Dexmedetomidine in combination with regional anaesthesia for upper airway blocks was used for smooth awake fibre optic naso-tracheal intubation. The present case is of an adult male patient who underwent oral maxillofacial surgery at a service hospital of the armed forces at a height of 12000 feet above mean sea level. 0.2 mg of Glycopyrrolate, 4 mg of Ondansetron were administered intravenously as pre- medication in the pre-op room 20 mins prior to wheeling the patient inside the operating room. In the operating room after attaching the standard ASA monitors the patient was administered with infusion of 0.3mcg/Kg/min of intra-venous Dexmedetomidine started 15 mins prior to the start of procedure. Oxygen was administered via nasal cannula at 4 L/min. An awake naso endotracheal intubation was performed after successful administration of regional block in the upper airways. The patient was successfully intubated and no complications were noted peri-operatively.