Vinayagam Stalin, Arikrishnan Thirumurugan, Kundra Pankaj, Saxena Sunil Kumar
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Ear, Nose and Throat, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
J Anaesthesiol Clin Pharmacol. 2022 Jan-Mar;38(1):124-129. doi: 10.4103/joacp.JOACP_209_20. Epub 2021 Dec 1.
Awake fibreoptic nasotracheal intubation is associated with adverse airway and hemodynamic complications. The aim of this study was to evaluate the role of endotracheal tube size on nasal and laryngeal morbidity during awake fibreoptic-guided nasotracheal intubation.
Eighty patients recruited to undergo awake fibreoptic intubation were randomly allocated to Group C (standard size endotracheal tube) and Group S (small size endotracheal tube followed by exchange to standard size using Airway Exchange Catheter under general anesthesia). Nasal morbidity was assessed by incidence of epistaxis, olfactory acuity, and mucociliary clearance. Patient discomfort during intubation was assessed using grimace score and hemodynamic parameters were recorded. Postoperatively, the incidence of nasal and laryngeal injury was recorded using nasendoscopy and telelaryngoscopy, respectively.
Demographic profile between the two groups was comparable. Epistaxis was noted in 47.5% of patients in group C as compared to 12.5% in group S. Postoperative olfactory acuity was decreased [2 (1-4) vs 4 (2-5)] and saccharin clearance time was prolonged (314 s vs 134 s) in Group C as compared to Group S. (-value <0.001) Higher grimace score [2 (1-3) vs 1 (0-2)] and increased hemodynamic response was demonstrated in Group C. (-value <0.001) Incidence of nasal injury [2 (1-4) vs 1 (0-2)] and laryngeal injury [1 (0-2) vs 0 (0-2)] was more in Group C as compared to Group S.
Awake fibreoptic nasotracheal intubation with small size endotracheal tube followed by exchange to standard size under general anesthesia reduces nasal, laryngeal, and hemodynamic complications.
清醒状态下纤维支气管镜引导经鼻气管插管与气道及血流动力学不良并发症相关。本研究旨在评估气管导管尺寸对清醒状态下纤维支气管镜引导经鼻气管插管时鼻和喉部并发症的影响。
招募80例拟行清醒状态下纤维支气管镜引导经鼻气管插管的患者，随机分为C组（标准尺寸气管导管）和S组（小尺寸气管导管，随后在全身麻醉下使用气道交换导管更换为标准尺寸）。通过鼻出血发生率、嗅觉敏锐度和黏液纤毛清除功能评估鼻部并发症。使用痛苦表情评分评估插管过程中患者的不适程度，并记录血流动力学参数。术后，分别使用鼻内镜和电子喉镜记录鼻和喉部损伤的发生率。
两组患者的人口统计学特征具有可比性。C组47.5%的患者出现鼻出血，而S组为12.5%。与S组相比，C组术后嗅觉敏锐度降低[2（1 - 4）对4（2 - 5）]，糖精清除时间延长（314秒对134秒）（P值<0.001）。C组患者的痛苦表情评分更高[2（1 - 3）对1（0 - 2）]，血流动力学反应增强（P值<0.001）。与S组相比，C组鼻损伤[2（1 - 4）对1（0 - 2）]和喉损伤[1（0 - 2）对0（0 - 2）]的发生率更高。
清醒状态下先使用小尺寸气管导管进行纤维支气管镜引导经鼻气管插管，随后在全身麻醉下更换为标准尺寸，可减少鼻、喉及血流动力学并发症。
