Sevoflurane Sedation as an Alternative for Awake Fiberoptic Intubation in Difficult Airway Patients

Tanta University70 enrolled

Overview

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

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Sevoflurane Sedation Awake Fiberoptic Intubation Difficult Airway

Interventions

SevofluraneDRUG

Patients will undergo fiberoptic intubation under sevoflurane sedation.

2% Xylocaine (2 ml )DRUG

Patients will undergo fiberoptic intubation with bilateral Superior Laryngeal Nerve block and Recurrent laryngeal nerve block.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 50 Years

Medical Language ↔ Plain English

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.

Locations (1)

Tanta University

Tanta, El-Gharbia, Egypt

RECRUITING

Outcomes

Primary Outcomes

Degree of patient satisfaction

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).

Time frame: Immediately after intubation

Secondary Outcomes

Intubation time

Intubation time (time from insertion of the fiberoptic bronchoscope throughout the nose till confirmation of intubation with capnography)

Time frame: Intraoperatively

Heart rate

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.

Time frame: 5 minutes after intubation

Mean arterial pressure

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.

Time frame: 5 minutes after intubation

Patient's tolerance to endoscopy

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).

Time frame: Intraoperatively

Patient's tolerance to intubation

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)

Central Contacts

Marwa A Abogabal, MD

CONTACT

00201004190210 Dr_mora1985@med.tanta.edu.eg

Data from ClinicalTrials.gov

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