Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial
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 betwee...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2020-11, Vol.64 (10), p.1414-1421 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | Deng, Meng Tu, Meng‐Yun Liu, Yi‐Heng Hu, Xiao‐Bing Zhang, Tao Wu, Jin‐Song Wang, Ying‐Wei |
| description | 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 |
| doi_str_mv | 10.1111/aas.13667 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2423804318</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2423804318</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3537-caa0cc5a6a6eabbaf2ec6ad7333c39033fcdd0677c6799115f2bf4da925580063</originalsourceid><addsrcrecordid>eNp1kcGOFCEURYnROD2jC3_AkLjRRc1AUUDjrtPR0WQSF-q68gqoDiMULVDp1Kz8BFd-oF8ibY8uTGTDg3ty8pKL0DNKLmk9VwD5kjIh5AO0okypRnApHqIVIYQ2nMr2DJ3nfFufrFPqMTpjreBqzbsV-rGNYQ_JTTtcDhGDSwdYcIAJdjbYqeBcEhS7czbjMSYcorHHD7_gbE0dDN5DcZXMeJ5qtotHFxzgi8U6weRiiWF5jTc418Dbn9--D95V0uCamhjcXR11nEqK3texJAf-CXo0gs_26f19gT6_ffNp-665-XD9fru5aTTjTDYagGjNQYCwMAwwtlYLMJIxppkijI3aGCKk1EIqRSkf22HsDKiW8zUhgl2glyfvPsWvs82lDy5r6z1MNs65b7uWrUnH6LqiL_5Bb-OcprpdpTpVQcmOwlcnSqeYc7Jjv08uQFp6SvpjWX0tq_9dVmWf3xvnIVjzl_zTTgWuTsDBebv839RvNh9Pyl8w-KLh</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2449423736</pqid></control><display><type>article</type><title>Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial</title><source>Wiley Online Library All Journals</source><creator>Deng, Meng ; Tu, Meng‐Yun ; Liu, Yi‐Heng ; Hu, Xiao‐Bing ; Zhang, Tao ; Wu, Jin‐Song ; Wang, Ying‐Wei</creator><creatorcontrib>Deng, Meng ; Tu, Meng‐Yun ; Liu, Yi‐Heng ; Hu, Xiao‐Bing ; Zhang, Tao ; Wu, Jin‐Song ; Wang, Ying‐Wei</creatorcontrib><description>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 (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.
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.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.13667</identifier><identifier>PMID: 32659854</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Airway management ; Anesthesia ; Carbon dioxide ; Clinical trials ; Complications ; Epiglottis ; Insertion ; Obstructions ; Palate ; Remission ; Respiratory tract ; Surgery ; Vocal cords</subject><ispartof>Acta anaesthesiologica Scandinavica, 2020-11, Vol.64 (10), p.1414-1421</ispartof><rights>2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-caa0cc5a6a6eabbaf2ec6ad7333c39033fcdd0677c6799115f2bf4da925580063</citedby><cites>FETCH-LOGICAL-c3537-caa0cc5a6a6eabbaf2ec6ad7333c39033fcdd0677c6799115f2bf4da925580063</cites><orcidid>0000-0002-2554-6611 ; 0000-0002-7778-2368 ; 0000-0002-1484-3039</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faas.13667$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faas.13667$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32659854$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deng, Meng</creatorcontrib><creatorcontrib>Tu, Meng‐Yun</creatorcontrib><creatorcontrib>Liu, Yi‐Heng</creatorcontrib><creatorcontrib>Hu, Xiao‐Bing</creatorcontrib><creatorcontrib>Zhang, Tao</creatorcontrib><creatorcontrib>Wu, Jin‐Song</creatorcontrib><creatorcontrib>Wang, Ying‐Wei</creatorcontrib><title>Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>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 (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.
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.</description><subject>Airway management</subject><subject>Anesthesia</subject><subject>Carbon dioxide</subject><subject>Clinical trials</subject><subject>Complications</subject><subject>Epiglottis</subject><subject>Insertion</subject><subject>Obstructions</subject><subject>Palate</subject><subject>Remission</subject><subject>Respiratory tract</subject><subject>Surgery</subject><subject>Vocal cords</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kcGOFCEURYnROD2jC3_AkLjRRc1AUUDjrtPR0WQSF-q68gqoDiMULVDp1Kz8BFd-oF8ibY8uTGTDg3ty8pKL0DNKLmk9VwD5kjIh5AO0okypRnApHqIVIYQ2nMr2DJ3nfFufrFPqMTpjreBqzbsV-rGNYQ_JTTtcDhGDSwdYcIAJdjbYqeBcEhS7czbjMSYcorHHD7_gbE0dDN5DcZXMeJ5qtotHFxzgi8U6weRiiWF5jTc418Dbn9--D95V0uCamhjcXR11nEqK3texJAf-CXo0gs_26f19gT6_ffNp-665-XD9fru5aTTjTDYagGjNQYCwMAwwtlYLMJIxppkijI3aGCKk1EIqRSkf22HsDKiW8zUhgl2glyfvPsWvs82lDy5r6z1MNs65b7uWrUnH6LqiL_5Bb-OcprpdpTpVQcmOwlcnSqeYc7Jjv08uQFp6SvpjWX0tq_9dVmWf3xvnIVjzl_zTTgWuTsDBebv839RvNh9Pyl8w-KLh</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Deng, Meng</creator><creator>Tu, Meng‐Yun</creator><creator>Liu, Yi‐Heng</creator><creator>Hu, Xiao‐Bing</creator><creator>Zhang, Tao</creator><creator>Wu, Jin‐Song</creator><creator>Wang, Ying‐Wei</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2554-6611</orcidid><orcidid>https://orcid.org/0000-0002-7778-2368</orcidid><orcidid>https://orcid.org/0000-0002-1484-3039</orcidid></search><sort><creationdate>202011</creationdate><title>Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial</title><author>Deng, Meng ; Tu, Meng‐Yun ; Liu, Yi‐Heng ; Hu, Xiao‐Bing ; Zhang, Tao ; Wu, Jin‐Song ; Wang, Ying‐Wei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-caa0cc5a6a6eabbaf2ec6ad7333c39033fcdd0677c6799115f2bf4da925580063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Airway management</topic><topic>Anesthesia</topic><topic>Carbon dioxide</topic><topic>Clinical trials</topic><topic>Complications</topic><topic>Epiglottis</topic><topic>Insertion</topic><topic>Obstructions</topic><topic>Palate</topic><topic>Remission</topic><topic>Respiratory tract</topic><topic>Surgery</topic><topic>Vocal cords</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deng, Meng</creatorcontrib><creatorcontrib>Tu, Meng‐Yun</creatorcontrib><creatorcontrib>Liu, Yi‐Heng</creatorcontrib><creatorcontrib>Hu, Xiao‐Bing</creatorcontrib><creatorcontrib>Zhang, Tao</creatorcontrib><creatorcontrib>Wu, Jin‐Song</creatorcontrib><creatorcontrib>Wang, Ying‐Wei</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deng, Meng</au><au>Tu, Meng‐Yun</au><au>Liu, Yi‐Heng</au><au>Hu, Xiao‐Bing</au><au>Zhang, Tao</au><au>Wu, Jin‐Song</au><au>Wang, Ying‐Wei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2020-11</date><risdate>2020</risdate><volume>64</volume><issue>10</issue><spage>1414</spage><epage>1421</epage><pages>1414-1421</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><abstract>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 (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.
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.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32659854</pmid><doi>10.1111/aas.13667</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2554-6611</orcidid><orcidid>https://orcid.org/0000-0002-7778-2368</orcidid><orcidid>https://orcid.org/0000-0002-1484-3039</orcidid></addata></record> |
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| source | Wiley Online Library All Journals |
| subjects | Airway management Anesthesia Carbon dioxide Clinical trials Complications Epiglottis Insertion Obstructions Palate Remission Respiratory tract Surgery Vocal cords |
| title | Comparing two airway management strategies for moderately sedated patients undergoing awake craniotomy: A single‐blinded randomized controlled trial |
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