Refractory airway hyperresponsiveness controlled with upper airway blocks during general anesthesia – a case report

Abstract

Tympanomastoidectomy with facial nerve monitoring usually impairs muscle relaxants' use. Airway hyperresponsiveness is common while manipula;ng a smoker's airway, par;cularly during endotracheal intuba;on. (1) Increasing the depth of anesthesia as well as blun;ng airway reflexes may be useful in these cases. (1) CASE REPORTThe potent reflex to airway's s;mula;on can be aDenuated by upper airway nerve blocks. (2) The described blocks are usually performed in awake/anesthe;zed laryngoscopy, awake fiberop;c bronchoscopy and as an adjuvant to general anesthesia to facilitate intuba;on without muscle relaxant. (2) They aDenuate catecholamine release and hemodynamic response to airway's manipula;on, with lower incidence of cough and bulking, providing significant analgesia. (2) Aspira;on is not a concern because swallowing reflex is preserved. (2) Upper airway blocks are useful in laryngoscopy, awake fiberop;c bronchoscopy and intuba;on without muscle relaxa;on and should be performed by skilled professionals.