Awake Blind Nasotracheal Intubation in Temporomandibular Joint Ankylosis Patients under Conscious Sedation Using Fentanyl and Midazolam.

BACKGROUND AND OBJECTIVES

Intubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngoscope is not available. Awake blind nasotracheal intubation requires sufficient patient co operation and comfort. Presently available short-acting analgesics and amnesics are excellent choices for this exercise.

STUDY DESIGN

This prospective randomized double blind study was designed to determine an appropriate dosage of fentanyl for awake blind nasotracheal intubation. We compared two different dosage of fentanyl. Eighty patients were randomly assigned to receive midazolam 0.05 mg/kg and fentanyl 2μg/kg in bolus (group I), or midazolam 0.05 mg/kg, fentanyl 3μg/kg in bolus (group II).

RESULTS

Both dosage regimen ensured patient comfort and sedation. Patients in group II were more calm and sedated as compared to group I. Hemodynamics was also more stable in group II.

CONCLUSION

For awake blind nasotracheal intubation, we therefore recommend midazolam 0.05mg/kg plus fentanyl 3μg/kg in bolus.