• Acta Anaesthesiol Scand · Nov 2020

    Randomized Controlled Trial

    Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: a single-blinded randomized controlled trial.

    • Meng Deng, Meng-Yun Tu, Yi-Heng Liu, Xiao-Bing Hu, Tao Zhang, Jin-Song Wu, and Ying-Wei Wang.
    • Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China.
    • Acta Anaesthesiol Scand. 2020 Nov 1; 64 (10): 1414-1421.

    BackgroundIn 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.MethodsSixty 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).ResultsThe 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 (EtCO2 ) 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.ConclusionThe below-epiglottis tube insertion is a more effective method to maintain upper airway patency than the nasopharyngeal airway for moderately sedated patients undergoing AC.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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