Optimal level of bispectral index for conscious sedation in awake fiberoptic nasotracheal intubation

Gnaneswaran, Hari Haran; Jain, Gaurav; Agarwal, Ankit; Chug, Ashi; Singla, Deepak

doi:10.1016/j.jobcr.2020.06.004

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Compared with fentanyl, dexmedetomidine provides better intubation conditions, lower hemodynamic response, and higher patient tolerance and satisfaction[ 19 , 20 ]. Dexmedetomidine in the dose range of 0.2 to 0.7 µg/kg/h did not inhibit respiration and maintained SpO 2 within the normal range[ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

Yang

Huang

et al. 2021

WJCC

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BACKGROUND Patients with ankylosing spondylitis (AS) combined with severe cervical fusion deformity have difficult airways. Awake fiberoptic intubation is the standard treatment for such patients. Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists. Bronchial blockers (BBs) have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation. AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB. METHODS We studied 12 AS patients (11 men and one woman) with lung or esophageal cancer who underwent thoracotomy with a BB. Preoperative airway evaluation found that all patients had a difficult airway. All patients received an intramuscular injection of penehyclidine hydrochloride (0.01 mg/kg) before anesthesia. In the operating room, dexmedetomidine(0.5 μg/kg) was infused intravenously for 10 min, with 2% lidocaine for airway surface anesthesia, and a 3% ephedrine cotton swab was used to contract the nasal mucosa vessels. Before tracheal intubation, fentanyl (1 μg/kg) and midazolam (0.02 mg/kg) were administered intravenously. Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position. Intravenous anesthesia was administered immediately after successful intubation, and a BB was inserted laterally. The pre-intubation preparation time, intubation time, facial grimace score, airway responsiveness score during the fiberoptic introduction, time of end tracheal catheter entry into the nostril, and lung collapse and surgical field score were measured. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded while entering the operation room (T1), before intubation (T2), immediately after intubation (T3), 2 min after intubation (T4), and 10 min after intubation (T5). After surgery, all patients were followed for adverse reactions such as epistaxis, sore throat, hoarseness, and dysphagia . RESULTS All patients had a history of AS (20.4 ± 9.6 years). They had a Willson's score of 5 or above, grade III or IV Mallampati tests, an inter-incisor distance of 2.9 ± 0.3 cm, and a thyromental (T-M) distance of 4.8 ± 0.7 cm. The average pre-intubation preparation time was 20.4 ± 3.4 min, intubation time was 2.6 ± 0.4 min, facial grimace score was 1.7 ± 0.7, airway responsiveness score was 1.1 ± 0.7, and pulmonary collapse and surgical exposure score was 1.2 ± 0.4. The SBP, DBP, and HR at T5 were significantly lower than those at T1-T4 ( P < 0.05). While the values at T1 were not significantly different from those at T2-T4 ( P > 0.05), they were significantly different from those at T5 ( P < 0.05)....

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Section: Discussionmentioning

confidence: 99%

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

Yang

Huang

et al. 2021

WJCC

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“…RSS should be around 2-3 and BIS should range between 80 and 86 for awake fiberoptic intubation (AFOI). 7,15,16 A variety of sedatives are in use for AFOI, in different doses, administered both as a single bolus or continuous infusion. The most popularly used of these is dexmedetomidine.…”

Section: Preparation and Checklist For Advanced Airway Managementmentioning

confidence: 99%

Difficult Airway Management in Surgical Intensive Care Unit

Chalam

2023

Journal of Acute Care

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A considerable number of patients in the surgical intensive care unit (ICU) require advanced airway management in terms of intubation or laryngeal mask airway (LMA) placements. It is not uncommon to come across difficult airways in ICU. A difficult airway cart with a fiberoptic bronchoscope and trained personnel are fundamental to the practice of surgical critical care. So, clinicians in ICU should be capable of carrying bronchoscopic intubation in sedated as well as awake patients. Anesthetizing techniques for awake fiberoptic bronchoscopic intubation (FOBI) such as airway blocks or topicalization and monitoring during the procedure are of considerable interest. It is equally important to keep the patient comfortable, maintaining spontaneous breathing and hemodynamic stability. Finally, combined techniques such as fiberoptic bronchoscope in combination with LMA or video laryngoscope (VL) do improve success rates of advanced airway management in surgical ICU (SICU).

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“…10 It has been demonstrated for over 20 years in a large variety of sedation settings to be superior to clinical assessment, because it is more accurate, allows more precise titration of sedatives, it does not require disturbing the patient and complication rates are reduced. [11][12][13][14][15][16] Despite this and the ongoing anxieties about sedation by non-anesthetists, uptake has been remarkably poor.…”

Section: Introductionmentioning

confidence: 99%

Safety of EEG BIS-guided nurse-administered procedural sedation during gastro-intestinal intervention

Oh,

Vasileuskaya,

Kibriya

et al. 2024

Int J Gastrointest Interv

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Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient's age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients' vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion: BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients' responsiveness to stimuli.

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Optimal level of bispectral index for conscious sedation in awake fiberoptic nasotracheal intubation

Cited by 6 publications

References 13 publications

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

Difficult Airway Management in Surgical Intensive Care Unit

Safety of EEG BIS-guided nurse-administered procedural sedation during gastro-intestinal intervention

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