A Comparative Study Between Two Monitoring Techniques of Awake Blind Nasal Intubations in Cases of Restricted Mouth Opening

Indian Journal of Applied Basic Medical Sciences
Year: 2020, Volume: 22(B), Issue. (2)
First page: (239) Last page: (260)
Online ISSN: 2249-7935
Print ISSN: 0975-8917
doi: 10.48165/ijabms.2020.22218

A Comparative Study Between Two Monitoring Techniques of Awake Blind Nasal Intubations in Cases of Restricted Mouth Opening
Bipin K Shah1*, Dhara Shah2, Hitesh Chelani3, Krishna Shah4, Sanjay Baldaniya5 and  Indu A Chadha6
1Associate Professor, 2Assistant Professor, 33rd year Resident, 42nd year resident, 51st year resident, 6Professor, Anaesthesia department GCS Medical college, Hospital and Research Centre Oppo. DRM Office, Near chamundabridge ,Naroda road, Ahmedabad
Corresponding Author: Bipin K Shah, Email: bipinkant@gmail.com

Online Published on 02-July-2020

ABSTRACT

Background: Intubating a patient with limited or nil mouth opening is always a challenge, particularly when fibreoptic laryngoscope is not available. Awake Blind Nasotracheal Intubation[ABNI] is one of the options for intubating such patients. It requires sufficient patient cooperation and comfort. Presently available short acting analgesics and amnesias are excellent choices for this exercise.Aims: The present study was to compare the two techniques while performing nasotracheal intubation: monitoring by spontaneous respiratory movement in rebreathing bag of breathing circuit, with monitoring by EtCO2 tubing attached to breathing circuit while performing [ABNI].Study Design: This prospective randomized study of 60 patients undergoing Commando surgery with anticipated difficult airway. They were randomly assigned into two groups of 30 each according to the method used for [ABNI]. After complete airway block, Group (A) patients were monitored by spontaneous respiratory movement in rebreathing bag of breathing circuit while performing [ABNI] and while Group (B) patients were monitored by EtCO2 tubing attached to breathing circuit while performing [ABNI]. 20 patients were intubated at first attempt, 6 at second and 4 patients at third attempt in Group A, while 21were intubated at first, 5 at second and 4 at third attempt in Group B. These differences were insignificant. The mean time required for successful intubation was in Group A (2.47± 0.068) min. and in Group B (2.42±0.057) min. which was insignificant. Also, success rate, hemodynamic changes and complications and severity score were comparable in both groups.
In conclusion: This study showed that both the techniques in performing [ABNI] are equally valuable. There was no significant difference between the success rates of both techniques. [ABNI] under topical anesthesia may provide an alternative safe method in anticipated difficult intubation, particularly if fiberoptic bronchoscope is not available.

Keywords

 Intubation: Awake blind nasal:Two monitoring techniques.