Blood Pressure and Heart Rate Changes during Awake Fiberoptic Nasotracheal Intubation

A comparison of the stress response to laryngoscopy

“…The use of local anaesthetic such as aerosolised lignocaine will reduce the effect of instrument stimulation but more effective is the reduction of the stimulus itself. The use of fibreoptic laryngoscopy has been associated with a reduction in both the heart rate and pressor response to laryngoscopy [24,28]. With fibreoptic laryngoscopy there is little oropharyngeal stimulation and the epiglottis is negotiated without having to lift the structures proximal to it.…”

Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation

“…Ovassapian and colleagues [8] considered that the heart rate and arterial pressure changes during fibreoptic nasal intubation in awake but sedated patients under local anaesthesia were small and likely to be less than those associated with rigid laryngoscopy. However, when Schrader and colleagues [9] compared awake oral fibreoptic intubation directly with awake oral rigid intubation, there were no clear differences between the responses to the two techniques, although the rigid intubation group did show a significant increase in mean arterial pressure not seen in the fibreoptic group.…”

Conscious sedation for awake fibreoptic intubation: a review of the literature

“…At one time or another, most opioids in common use have been used as adjuncts to sedation for AFOI. Prior to the introduction of remifentanil, incremental boluses of fentanyl or occasionally alfentanil, usually in combination with a benzodiazepine, such as diazepam or midazolam, were used most frequently [1][2][3]5,6,17 Nevertheless, boluses of opioids with midazolam for sedation can be associated with significant hypoxemia (SaO 2 \ 90%), apnea, and even aspiration. 18,19 Opioids have also been used as premedication by either the oral or intramuscular route, the latter most commonly morphine 5-10 mg.…”

“…When they reported increases of C20 mmHg in mean arterial pressure and C20 beatsÁmin -1 in heart rate in 30% of their patients. 2 It could be argued that the relatively long loading time of the first dose of dexmedetomidine may be a disadvantage; however, the main adverse effects reported with its use are bradycardia and hypotension. 39,50 Although the former generally doesn't appear to be a significant problem (possibly due to the concurrent use of glycopyrrolate in most studies), hypotension may be, particularly following subsequent induction of general anesthesia.…”