End-tidal carbon dioxide monitoring during awake blind nasotracheal intubation.
OBJECTIVE
To test the usefulness of the end-tidal carbon dioxide monitor in facilitating awake blind nasotracheal intubation in patients with potentially difficult airways.


METHODS
Randomized, controlled comparison of regimen.


METHODS
Inpatient surgery clinic at a university hospital.


METHODS
Sixty-one consecutive patients with potentially difficult airways.


METHODS
After airway anesthesia with 4% lidocaine was administered to all patients, either fentanyl and diazepam (n = 30) or fentanyl alone (n = 31) was given intravenously before the awake blind nasotracheal intubation procedure.


RESULTS
End-tidal carbon dioxide concentration, arterial blood pressure, heart rate, and arterial oxygen saturation (by pulse oximeter) were measured in each patient during the awake blind nasotracheal intubation procedure. The day after anesthesia and surgery, each patient was asked to assess the degree of discomfort experienced during the procedure. In 54 of 61 patients, the end-tidal carbon dioxide monitor facilitated awake blind nasotracheal intubation. End-tidal carbon dioxide was significantly higher in patients given both fentanyl and diazepam than in those given fentanyl alone (7.4% +/- 1.4% vs 5.9% +/- 0.9%, respectively; p less than 0.05), but no patient in either group recalled the awake intubation as extremely uncomfortable.


CONCLUSIONS
Monitoring of end-tidal carbon dioxide is useful and valuable in both facilitating blind nasotracheal intubation and avoiding profound hypoventilation.
Dohi
S
S
Department of Anesthesiology, University of Tsukuba, Ibaraki, Japan.
Inomata
S
S
Tanaka
M
M
Ishizawa
Y
Y
Matsumiya
N
N
D000771:Anesthesia, Intravenous; D000772:Anesthesia, Local; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000032:analysis*; D003243:Consciousness; D003975:Diazepam; D005283:Fentanyl; D006339:Heart Rate; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008012:Lidocaine; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009666:Nose; D009960:Oropharynx; D010100:Oxygen / Q000097:blood; D011229:Preanesthetic Medication; D013990:Tidal Volume
D002245:Carbon Dioxide; D008012:Lidocaine; D003975:Diazepam; D010100:Oxygen; D005283:Fentanyl