Ultrasound-Guided Glossopharyngeal Nerve Block for an Awake Intubation in a Patient Predicted to Have a Difficult Airway: A Case Report

Wada, Nozomi; Furutani, Akiko; Tokumine, Joho; Shimazu, Keisuke; Yorozu, Tomoko

doi:10.1213/xaa.0000000000001682

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Local nasal sprays with vasoconstrictor are recommended before nasal intubation, and nasal drops with lidocaine combined with phenylephrine are suitable 1 . The nerve blocks that may be used if anesthesiologists have technical skills, adequate visualization techniques, and experience especially under ultrasound 8 . Using supplemental oxygen is suggested for the patients who will receive sedation.…”

Section: Discussionmentioning

confidence: 99%

“…1 The nerve blocks that may be used if anesthesiologists have technical skills, adequate visualization techniques, and experience especially under ultrasound. 8 Using supplemental oxygen is suggested for the patients who will receive sedation. The methods to keep normal oxygenation include nasal catheter, face mask, supraglottic jet ventilation, and oxygenation (SJOV) 9 and HFNC with oxygen flow of 30-70 L/min.…”

Section: Discussionmentioning

confidence: 99%

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An optimized “sTOP” strategy‐based awake fiberoptic intubation for a patient with severe scoliosis after halo‐pelvic traction

Liang

Huo

Sun

et al. 2023

Clinical Case Reports

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Difficult Airway Society launched the new guideline for awake tracheal intubation (ATI) in adults with the goal of standardizing and promoting ATI techniques to protect the airway in 2020 (Anaesthesia, 2020;75:509). Specifically, the guideline highlighted that the key components of ATI are sedation, topicalization, oxygenation, and performance, coined “sTOP.” To the best of our knowledge, anticipated difficult airway is the best indication for ATI. Patients with severe scoliosis undergoing halo‐pelvic traction (HPT) are often with head and neck fixation, thereby contributing to the anticipated difficult airways. HPT was first used to fix unstable cervical vertebra segments in 1959, and gradually applied in the treatment of scoliosis (scoliosis or kyphosis Angle greater than 90 degrees is usually considered as severe scoliosis), with favorable efficacy and safety profile, and thus widely used in clinical practice (Clin Orthop Relat Res, 1973;93:179). To date, the improved HPT device usually consists of a head ring composed of 6 ~ 8 cranial nails, a pelvic ring composed of 6 ~ 8 iliac bone nails and 4 telescopic connecting rods, which can achieve all‐day continuous traction. Usually, the average traction time was about 8 weeks (Chin Med J (Engt), 2012;125:1297). Our case described a planned awake fiberoptic intubation (AFOI) for a patient with severe scoliosis undergoing HPT via an optimized “sTOP” strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An optimized “sTOP” strategy‐based awake fiberoptic intubation for a patient with severe scoliosis after halo‐pelvic traction

Liang

Huo

Sun

et al. 2023

Clinical Case Reports

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Optimizing nonintubated laryngeal microsurgery: The effectiveness and safety of superior laryngeal nerve block with high-flow nasal oxygen—A prospective cohort study

Kuo,

Chang,

Tsai

et al. 2024

Journal of the Chinese Medical Association

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Background: Laryngeal microsurgery (LMS) typically requires intubated general anaesthesia. Although nonintubated general anaesthesia (NIGA) with high-flow nasal oxygen (HFNO) can be applied with LMS, a muscle relaxant is required, which can cause apnoea and hypercapnia. This study evaluated the effectiveness of a superior laryngeal nerve block (SLNB) in improving safety during LMS. Methods: This prospective cohort study enrolled a cumulative total of 61 adult patients received LMS under intravenous general anesthesia and allocated to three groups: intubated general anesthesia (ITGA) group (n = 18), which patients performed intubation; neuromuscular blocking (NMB) group (n = 21), which patients administrated muscle relaxant without intubation and superior laryngeal nerve block (NB) group (n = 22), which patients performed SLNB without intubation or muscle relaxant. Results: The average (standard deviation) values of PaCO2 after surgery in ITGA, NMB and NB group were 50.8 (7.5), 97.5 (24.9) and 54.8 (8.8) mmHg, respectively. The mean postoperative pH values were 7.33 (0.04), 7.14 (0.07), and 7.33 (0.04), respectively. The results were all p<0.001, and the average pH value of the NMB group was lower than that of the ITGA and NB groups. During the LMS, the mean HR (93.9 [18.1] bpm) and NBPs (143.5 [28.2] mmHg) in the NMB group were higher than those in the ITGA group (HR 77.4 [13.5] bpm and NBPs 132.7 [20.8] mmHg) and NB group (HR 82.3 [17.4] bpm and NBPs 120.9 [25.0] mmHg). The results of p value by HR and NBPs are p<0.001. The PaCO2 and pH values are similar between ITGA group and NB group. Conclusion: Our approach of using HFNO with SLNB was successful for performing nonintubated LMS, enabling the patients to maintain spontaneous breathing and effectively eliminate CO2. This approach reduces the risks of hypercapnia and acidosis even when the duration of LMS exceeds 30 min.

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Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

Kang,

Park,

Jin

2024

World J Clin Cases

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BACKGROUND Awake fiberoptic nasotracheal intubation (AFNI) is the preferred airway management strategy for patients with difficult airways. However, this procedure can cause significant physical and psychological distress. This case report explores the application of a sphenopalatine ganglion (SPG) block as an alternative analgesic modality to mitigate the discomfort associated with AFNI. CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion. The patient’s medical history included prior surgery, chemotherapy, and radiation therapy, resulting in significant jaw impairment and limited neck mobility. Considering the anticipated airway challenges, AFNI was planned. A SPG block was performed under real-time ultrasound guidance, providing effective analgesia during nasotracheal intubation. CONCLUSION The SPG block represents a promising analgesic approach in AFNI, offering potential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

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Ultrasound-Guided Glossopharyngeal Nerve Block for an Awake Intubation in a Patient Predicted to Have a Difficult Airway: A Case Report

Cited by 3 publications

References 14 publications

An optimized “sTOP” strategy‐based awake fiberoptic intubation for a patient with severe scoliosis after halo‐pelvic traction

An optimized “sTOP” strategy‐based awake fiberoptic intubation for a patient with severe scoliosis after halo‐pelvic traction

Optimizing nonintubated laryngeal microsurgery: The effectiveness and safety of superior laryngeal nerve block with high-flow nasal oxygen—A prospective cohort study

Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

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