The use of dexmedetomidine in fibrooptic tracheal intubation in patients with predictable difficult respiratory tract during head and neck surgical interventions
https://doi.org/10.21292/2078-5658-2019-16-5-56-59
Abstract
The study included 31 oncological patients who underwent surgical treatment for head and neck tumors. Airway patency was assured by fibrooptic intubation of the trachea while preserving the patient's spontaneous breathing. 15-20 min before the fibrooptic tracheal intubation, dexmedetomidine was administered intravenously at the dose of 3 μg/kg per 1 h until the loading dose of 1 μg/kg was reached. Fibrooptic intubation of the trachea had been applied till the patient's sedation exceeded 3 scores on the Ramsay sedation scale. In all observations, patients maintained spontaneous breathing. Immediately prior to the introduction of the fibrobronchoscope, lidocaine in the dose of 1.5 mg/kg and ketamine (0.5 mg/kg) were administered intravenously. Further, fibrooptic tracheal intubation was carried out, the quality of which was evaluated by the anesthesiologist directly while it was performed and by the patient in the postoperative period.
About the Authors
A. A. Pаstukhovа
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Anna A. Pastukhova - Anesthesiologist and Emergency Physician.
6-8, Lva Tolstogo St., St. Petersburg, 197022
Phone: +7 (812) 429‒03‒31.
M. N. Gurin
Petrov National Medical Research Center of Oncology
Russian Federation
Russian Federation
Mikhail N. Gurin - Anesthesiologist and Emergency Physician.
68, Leningradskaya St., Settlement of Pesochny, St. Petersburg, 197758.
Phone: +7 (812) 439‒95‒09.
S. A. Rozengаrd
Petrov National Medical Research Center of Oncology
Russian Federation
Russian Federation
Sergey A. Rozengard - Candidate of Medical Sciences, Head of Anesthesiology and Intensive Care Department.
68, Leningradskaya St., Settlement of Pesochny, St. Petersburg, 197758.
Phone: +7 (812) 439‒95‒09.
V. A. Gluschenko
Petrov National Medical Research Center of Oncology
Russian Federation
Russian Federation
Vladimir A. Gluschenko - Doctor of Medical Sciences, Associate Professor, Head of Research Department of Anesthesiology, Intensive Care and Algology.
68, Leningradskaya St., Settlement of Pesochny, St. Petersburg, 197758.
Phone: +7 (812) 439‒95‒09.
References
1. Balandin V.V., Gorobets E.S. Non-opioid anesthesia, alagesia and sedation in the surfery of head and neck cancer. Anesteziologiya i Reanimatologiya, 2015, no. 6, pp. 39-42. (In Russ.)
2. Balandin V.V., Gorobets E.S. The first experience of opiod-free anesthesia/analgesia based on dexmedetomidine for oncological surgeries on head and neck in patients with "difficult respiratory tract'. Vestnik Anesteziologii I Reanimatologii, 2013, no. 5, pp. 9-12. (In Russ.)
3. Volkov P.А., Churadze B.T., Sevalkin S.А., Volkova Yu.N. Dexmedetomidine as a analgesic component of general anesthesia in laparoscopic surgeries. Anesteziologiya i Reanimatologiya, 2015, no. 1, pp. 4-8. (In Russ.)
4. Dolbneva E.L., Stamov V.I., Mizikov V.M. et al. "Difficult respiratory tract" – its frequency in Russia and ways of management. Tezisy XIV sezda Federatsii anesteziologov i reanimatologov. [Abstract Book of the XIV Congress of Anesthesiologists and Emergency Physicians Federation]. pp. 116-117. (In Russ.)
5. Klinicheskie rekomendatsii Federatsii anesteziologov i reanimatologov «Obespechenie prokhodimosti verkhnikh dykhatelnykh putey v statsionare». Vtoroy peresmotr. Utverzhdeny Prezidiumom FАR 30 marta 2018 g. [Clinical recommendations by Anesthesiologists and Emergency Physicians Federation on Provision of Potency of Upper Respiratory Tract in the In-Patient Unit. The second revision. Approved by the FAR Board as of March 30, 2018].
6. Kulikov А.S., Lubnin А.Yu. Dexmedetomidine: new opportunities in the anesthesiology. Anesteziologiya i Reanimatologiya, 2013, no. 1, pp. 37-41. (In Russ.)
7. Chopra P., Dixit M.B., Dang A. et. al. Dexmedetomidine provides optimum conditions during awake fibreoptic intubation in simulated spine injury patients. J. Anaesthesiol. Clin. Pharmacology, 2016, no. 1, pp. 54‒58.
8. Clivio S., Putzu A., Tramer M.R. et. al. Intravenous lidocaine for the prevention of cough: systematic review and meta-analysis of randomized controlled trials. Anesthesia&Analgesia, August 29, 2018, volume published ahead of print.
9. Herminghaus A., Wachowiak M., Wilhelm W. et. al. Intravenous administration of lidocaine for perioperative analgesia. Rewiew and recommendations for practical usage. Anesthesist, 2011, no. 2, pp. 152.
10. Johnston K.D., Rai M.R., Leslie D. Conscious sedation for awake fibreoptic intubation: a review of the literature. Canadian Anesthesiologists’ Society, 2013, no. 60, pp. 584‒599.
11. Mahajan L., Kaur M., Gupta R. et. al. Attenuation of the pressor responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomide versus magnesium sulphate under bispectral index-controlled anaesthesia: A placebo-controlled prospective randomized trial. Indian J. Anaesth., 2018, no. 5, pp. 337‒343.
12. Modir H., Yazdi B., Moshiri E. et. al. Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: a randomized clinical trial. Med. Gas Res., 2018, no. 3, pp. 85‒90.
13. Practice Guidelines for Management of the Difficult Airway: An updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology, 2013, no. 118, pp. 251‒270.
14. Scher C.S., Melvin C., Gitlin M. Dexmedetomidine and low-dose ketamine provide adequate sedation for awake fibreoptic intubation. Can. J. Anesthes., 2003, no. 6, pp. 607‒610.
15. Shan T.H., Badve M.S., Olajide K.O. et. al. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Fell syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section. Clinics and Practice, 2011, no. 3, pp. 57.
16. Sharma J., Purohit S., Bhatia S. et. al. Awake orotracheal fibre-optic intubation: Comparison of two different doses of dexmedetomidine on intubation conditions in patients undergoing cervical spine surgery. Indian J. Anaesthesia, 2017, no. 10, pp. 811‒817.
17. Sinha S.K., Joshiraj B., Chaudhary L. et. al. A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fibreoptic nasotracheal intubation: a randomized controlled study. J. Anaesthesiol. Clin. Pharmacology, 2014, no. 4, pp. 514‒519.
18. Tsai C.J., Chu K.S., Chen T.I. et. al. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia, 2010, no. 65, pp. 254‒259.
Review
For citations:
Pаstukhovа A.A., Gurin M.N., Rozengаrd S.A., Gluschenko V.A. The use of dexmedetomidine in fibrooptic tracheal intubation in patients with predictable difficult respiratory tract during head and neck surgical interventions. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(5):56-59. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-5-56-59
Email this article 