Abstract
Background: Awake fiberoptic intubation (AFOI) is commonly used for patients with a difficult airway. The purpose of this study was to evaluate the efficacy of cricothyroid membrane puncture anesthesia and topical anesthesia during AFOI.Methods: A total of 70 patients (the American Society of Anesthesiologists score I-III) with anticipated difficult airways scheduled for nonemergency surgery with AFOI were randomly slated to receive cricothyroid membrane puncture anesthesia (n = 35) or topical anesthesia (n = 35). Each group received dexmedetomidine at a dose of 1.0 μg/kg and sufentanil at a dose of 0.2 μg/kg over 10 min for conscious sedation before intubation. The endoscopy intubation, post-intubation condition, and endoscopy tolerance as scored by the anesthetists were observed. The satisfaction of the operator regarding the procedure and the satisfaction of the patient 24 h after the surgery were also recorded. We recorded the success rate of the first intubation, intubation time, and hemodynamic changes during the procedure and also the adverse events.Results: Better intubation scores, operator satisfaction, and satisfaction of the patient were observed in the cricothyroid membrane puncture anesthesia group than in the topical anesthesia group (p < 0.05). The intubation time in the cricothyroid membrane puncture anesthesia group was less than that in the topical anesthesia group (p < 0.05). There were no significant differences in the patient tolerance scores, the success rate of the first intubation, hemodynamic changes, and adverse events between both the groups.Conclusion: Compared with topical anesthesia, cricothyroid membrane puncture anesthesia provided better intubation conditions and less intubation time with greater satisfaction of the patient and operator during endoscopic intubation.Clinical Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=42636, Identifier: ChiCTR 1900025820.
Highlights
The incidence of the difficult airway during clinical anesthesia is as high as 4.5–7.5% [1]; this is a significant issue, as failure to maintain an unobstructed patient airway may lead to hypoxemia, brain damage, or even death [2]
Better intubation scores, operator satisfaction, and satisfaction of the patient were observed in the cricothyroid membrane puncture anesthesia group than in the topical anesthesia group (p < 0.05)
This study showed that both the cricothyroid membrane puncture anesthesia and topical anesthesia were effective for Awake fiberoptic intubation (AFOI), but the cricothyroid membrane puncture anesthesia technique required less intubation time and led to better intubation scores, a higher success rate of first intubation, FIGURE 2 | Heart rate (HR), mean arterial blood pressure (MAP), and peripheral oxygen saturation (SpO2) before premedication, immediately after drug infusion, and immediately after intubation
Summary
The incidence of the difficult airway during clinical anesthesia is as high as 4.5–7.5% [1]; this is a significant issue, as failure to maintain an unobstructed patient airway may lead to hypoxemia, brain damage, or even death [2]. Optimal intubation conditions for AFOI are as follows: the patient should be comfortable, cooperative, and have hemodynamic stability; the anesthesiologist must be able to maintain the airway of the patient with spontaneous ventilation [5]. To achieve these conditions, adequate conscious sedation and high-grade local anesthesia are required. To the best of our knowledge, there is no previous study that has compared topical anesthesia and cricothyroid membrane puncture anesthesia in awake fiberoptic nasotracheal intubation. This study was designed to compare the efficacy of the topical anesthesia and cricothyroid membrane puncture anesthesia in patients with difficult airway during AFOI.
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