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Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial
Author(s) -
Deng Meng,
Tu MengYun,
Liu YiHeng,
Hu XiaoBing,
Zhang Tao,
Wu JinSong,
Wang YingWei
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13667
Subject(s) - medicine , randomized controlled trial , anesthesia , double blinded , blinded study , craniotomy , airway management , airway , surgery , placebo , alternative medicine , pathology
Background In the monitored anesthesia care (MAC) setting for awake craniotomy (AC), maintaining airway patency in sedated patients remains challenging. This randomized controlled trial aimed to compare the validity of the below‐epiglottis transnasal tube insertion (the tip of the tube placed between the epiglottis and vocal cords) and the nasopharyngeal airway (simulated by the above‐epiglottis transnasal tube with the tip of the tube placed between the epiglottis and the free edge of the soft palate) with respect to maintaining upper airway patency for moderately sedated patients undergoing AC. Methods Sixty patients scheduled for elective AC were randomized to receive below‐epiglottis (n = 30) or above‐epiglottis (n = 30) transnasal tube insertion before surgery. Moderate sedation was maintained in the pre‐ and post‐awake phases. The primary outcome was the upper airway obstruction (UAO) remission rate (relieved obstructions after tube insertion/the total number of obstructions before tube insertion). Results The UAO remission rate was higher in the below‐epiglottis group [100% (12/12) vs 45% (5/11); P = .005]. The tidal volume values monitored through the tube were greater in the below‐epiglottis group during the pre‐awake phase ( P < .001). End‐tidal carbon dioxide (EtCO 2 ) monitored through the tube was higher in the below‐epiglottis group at bone flap removal ( P < .001). During the awake phase, patients' ability to speak was not impeded. No patient had serious complications related to the tube. Conclusion The below‐epiglottis tube insertion is a more effective method to maintain upper airway patency than the nasopharyngeal airway for moderately sedated patients undergoing AC.