2018 Volume 46 Issue 1 Pages 43-45
A case of awake fiber optic intubation using dexmedetomidine and a translaryngeal block for enlarged reoperative surgery performed ten days after the initial operation is reported. The patient was a 63-year-old woman. She had undergone the removal of a section of her left cheek mucosa because of a malignant tumor. A left cervical dissection and a left lateral femoral flap were also performed. Ten days later, enlarged reoperative surgery was considered ; however, mask ventilation was thought to be difficult, as her mouth could only open to about 20 mm. Using dexmedetomidine and a translaryngeal block, awake nasal fiber optic intubation (AFOI) was performed. Dexmedetomidine was continuously administered at a starting dose of 6 μg/kg/h under oxygen administration. In addition, 2 ml of 4% lidocaine was injected into the trachea through a 22 gauge needle to obtain the translaryngeal block. The patient coughed because of a tracheal reflex. After inserting the notched nasal airway into the right nasal cavity, AFOI was performed. The Ramsay score during the procedure was level 2, and the patients was cooperative. The percutaneous oxygen saturation level was 98%-100%, and spontaneous respiration was maintained. No coughing reflex was observed when the fiber optic bronchoscopy passed through the glottis. One day after the surgery, the patient reported that she did not feel any distress or discomfort during the intubation procedure. Thus, AFOI using dexmedetomidine and a translaryngeal block for enlarged reoperative surgery was successfully performed.
