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End-tidal carbon dioxide monitoring during awake blind nasotracheal intubation
Study Objective:
To test the usefulness of the end-tidal carbon dioxide monitor in facilitating awake blind nasotracheal intubation in patients with potentially difficult airways.
Design:
Randomized, controlled comparison of regimen.
Setting:
Inpatient surgery clinic at a university hospital.
Patients:
Sixty-one consecutive patients with potentially difficult airways.
Interventions:
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.
Measurements And Main 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.