Department of Anaesthesia, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany.
J Neurosurg Anesthesiol. 2012 Jul;24(3):217-21. doi: 10.1097/ANA.0b013e31824da7e5.
This study was designed to document the feasibility of self-positioning after awake fiberoptic intubation of the trachea using primarily effective topical anesthesia rather than sedation.
We investigated 14 patients (ASA physical status 1 to 3) with a neurosurgical diagnosis of cervical instability or at risk of secondary cervical injury, who were scheduled for awake fiberoptic intubation and self-positioning prone. Topical anesthesia was accomplished using an oropharyngeal spray of lidocaine alone or in combination with a transtracheal injection of lidocaine for awake fiberoptic intubation and self-positioning prone. Patients evidencing anxiolysis were given midazolam 2 to 4 mg, i.v.. We assessed the need for sedation, tolerance of the endotracheal tube, patient comfort, incidence of coughing or gagging, and changes in heart rate, blood pressure, and oxygen saturation. In addition, patients were interviewed on the first postoperative day and asked to categorize the experience of awake intubation and positioning as a positive, neutral, or negative experience, or to have no recall.
Eleven of the 14 patients turned themselves prone after awake fiberoptic intubation. No additional sedation was necessary for accomplishing positioning. Whereas 50% of the patients (7/14) showed mostly slight coughing or gagging during fiberoptic intubation, none of the patients who were positioned awake had coughing or gagging during tube fixation and prone positioning. The technique was unsuccessful in 3 patients. None of the patients viewed this as a negative experience.
Our study demonstrates that awake fiberoptic intubation and patient self-positioning was feasible in this sample of patients at risk of secondary cervical injury. This technique may extend the opportunity of continuous neurological monitoring in patients with a risk of position-related cervical injury, especially where electrophysiological monitoring is not possible or is unavailable.
本研究旨在记录在主要使用有效的局部麻醉而不是镇静的情况下，清醒纤维支气管镜气管插管后自行定位的可行性。
我们调查了 14 名（ASA 身体状况 1 至 3 级）有颈椎不稳定或有继发性颈椎损伤风险的神经外科诊断的患者，他们计划进行清醒纤维支气管镜插管和自行俯卧位。局部麻醉采用利多卡因咽部喷雾或联合利多卡因经气管内注射进行清醒纤维支气管镜插管和自行俯卧位。出现焦虑缓解的患者给予咪达唑仑 2 至 4mg，静脉注射。我们评估了镇静的需要、对气管内导管的耐受性、患者舒适度、咳嗽或呛咳的发生率以及心率、血压和血氧饱和度的变化。此外，患者在术后第一天接受采访，并被要求将清醒插管和定位的体验归类为积极、中性或消极体验，或无记忆。
14 名患者中有 11 名在清醒纤维支气管镜插管后自行俯卧位。完成定位不需要额外的镇静。虽然 50%的患者（14 例中有 7 例）在纤维支气管镜插管期间主要表现为轻微咳嗽或呛咳，但在气管固定和俯卧位时，没有患者出现咳嗽或呛咳。该技术在 3 名患者中失败。没有患者认为这是一种负面体验。
我们的研究表明，在有继发性颈椎损伤风险的这组患者中，清醒纤维支气管镜插管和患者自行定位是可行的。这种技术可能会为有与位置相关的颈椎损伤风险的患者提供持续神经监测的机会，特别是在无法进行或无法获得电生理监测的情况下。
