中华医学杂志（英文版）2009，Vol.122Issue(4)：408-415,8.DOI:10.3760/cma.j.issn.0366-6999.2009.04.0010
Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways
Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways
XUE Fu-shan 1HE Nong 2LIAO Xu 1XU Xiu-Zheng 2XU Yachao 1YANG Quan-yong 1LUO Mao-ping 1ZHANG Yan-ming1
作者信息
- 1. Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
- 2. Department of Anesthesiology, Peking University Shougang Hospital, Beijing 100144, China
- 折叠
摘要
Abstract
Background There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation (ETI), therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways.Methods Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic (two doses) and laryngotracheal areas (one dose) using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores (VAS), and objective assessments by an independent investigator using patients' tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters.Results Of 210 airway sprays, 197 (93.8%) were successfully completed on the first attempt. The total time for airway spray was (14.6±1.5) minutes. During airway topical anesthesia, the average patients' tolerance scores were 1.7-2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients' reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were less than 20% of baseline values. The postoperative follow-up showed that 95.7% of patients had no recall or slight memories of all airway instrumentation. The incidence of postoperative mild airway complications was 38.6%.Conclusion Alone use of the lightwand technique can achieve effective, safe and successful awake ETI in patients with difficult airways.关键词
difficult airways/ airway topical anesthesia/ awake endotracheal intubation/ lightwand techniqueKey words
difficult airways/ airway topical anesthesia/ awake endotracheal intubation/ lightwand technique分类
医药卫生引用本文复制引用
XUE Fu-shan,HE Nong ,LIAO Xu ,XU Xiu-Zheng,XU Yachao ,YANG Quan-yong,LUO Mao-ping,ZHANG Yan-ming..Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways[J].中华医学杂志（英文版）,2009,122(4):408-415,8.
