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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 42  |  Issue : 2  |  Page : 101-102

A novel method for airway management during procedural sedation and analgesia


1 Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
2 Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center; Department of Anesthesiology, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
3 Department of Anesthesiology, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan

Date of Submission20-Aug-2020
Date of Decision23-Aug-2020
Date of Acceptance25-Nov-2020
Date of Web Publication03-Feb-2021

Correspondence Address:
Dr. Chun-Chang Yeh
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District 114, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmedsci.jmedsci_271_20

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How to cite this article:
Tseng WC, Chiu TH, Lin WL, Yeh CC. A novel method for airway management during procedural sedation and analgesia. J Med Sci 2022;42:101-2

How to cite this URL:
Tseng WC, Chiu TH, Lin WL, Yeh CC. A novel method for airway management during procedural sedation and analgesia. J Med Sci [serial online] 2022 [cited 2022 May 23];42:101-2. Available from: https://www.jmedscindmc.com/text.asp?2022/42/2/101/308690



Dear Editor,

Procedural sedation and analgesia (PSA) has been widely used in acute care and outpatient settings to alleviate pain and anxiety during diagnostic and surgical interventions.[1] However, adverse airway and respiratory events may develop along with increased levels of PSA.[1],[2] In addition, some intravenous anesthetics such as propofol are associated with hypersalivation,[3] which may result in increased risks of choking and laryngospasm. Accordingly, optimal airway management during PSA is crucial to ensure patient safety.

In general, patients undergoing PSA are oxygenated through a nasal cannula or simple mask. Once adverse airway and respiratory events occur, advanced airway management should be promptly executed. Nasopharyngeal airway (NPA) is one of the essential devices for airway rescue during PSA.[2],[4] It can sustain a patent airway and bypass upper airway obstruction, thus preventing severe cardiopulmonary complications.[4] Herein, we intend to introduce a modified device as an alternative of NPA to enhance procedural safety in patients with predicted airway problems or under prolonged PSA.

The modified device is composed of a shortened surgical connecting tube (SCT) and easily available accessories [Figure 1]. According to our previous study on the optimal insertion depth of NPA, the length of the shortened SCT is determined by the distance from the patient's philtrum to ear tragus.[5] A connector of an endotracheal tube is inserted into one end of the shortened SCT. Then, we lubricate the shortened SCT and insert into the nasal cavity until the connector approaches the nostril. After confirming airway patency, we insert and fix a tracheal suction tube with 2 cm in depth within the shortened SCT through the connector. Finally, the proximal end of the tracheal suction tube is connected to the anesthesia station via the oxygenating tube and breathing circuit [Figure 2] and [Figure 3].
Figure 1: View of components of the modified oxygenating device as following: (1) surgical connecting tube, (2) connector of endotracheal tube, (3) elastic tape, (4) tracheal suction tube, (5) oxygenating tube (with simple mask), and (6) breathing circuit

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Figure 2: View of the modified oxygenating device connected to the anesthesia station via the oxygenating tube and breathing circuit

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Figure 3: View of clinical practice in a woman undergoing debridement under procedural sedation and analgesia

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The device not only remains inherent advantages of NPA but also provides additional benefits as following: (1) the softer and more elastic nature of the SCT reduce the incidence of mucosa trauma while insertion into the nasal cavity; (2) the device offers an easier access to eliminate accumulated secretions as clinically required; (3) the extensional device ensures adequate oxygenation even if the patient's head is away from the anesthesia provider; and (4) the device can be further connected to the end-tidal CO2 monitor to detect the patient's ventilation status.

Because the tip of the shortened SCT is positioned near to the laryngopharynx, the modified design theoretically provides a higher concentration of inhaled oxygen compared with that offered by a nasal cannula. For confirming our hypothesis, we obtained arterial blood gas data in a middle-aged female receiving a constant target-controlled infusion of propofol (Ce: 2.0 mcg/mL) under different oxygenating methods. Initially, we supplied the patient with 6 L/min of oxygen (FiO2: 40%) through a nasal cannula for 5 min. Subsequently, we switched the nasal cannula to our modified device and bag-valve-mask ventilation for repeated 5-min intervals. After 5-min use of all three oxygenating methods, we obtained arterial blood samples via the arterial line. The details of arterial blood gas data are presented in [Table 1]. Comparisons among three methods revealed that our newly designed device provided more efficient oxygen delivery than traditional nasal cannula and similar oxygenation to bag-valve-mask ventilation.
Table 1: The details of arterial blood gas samples with different oxygenating methods

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In conclusion, the modified oxygenating device is easily instituted and can be regarded as an alternative for airway management during PSA, especially in patients having expected airway promise and undergoing prolonged procedures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hinkelbein J, Lamperti M, Akeson J, Santos J, Costa J, de Robertis E, et al. European Society of Anaesthesiology and European Board of Anaesthesiology Guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018;35:6-24.  Back to cited text no. 1
    
2.
Thackeray EM, Johnson KB. Airway rescue during sedation: A proposed airway rescue pathway for nonanesthesiologists. Curr Opin Anaesthesiol 2019;32:464-71.  Back to cited text no. 2
    
3.
Lai HC, Chang YH, Huang RC, Hung NK, Lu CH, Chen JH, et al. Efficacy of sevoflurane as an adjuvant to propofol-based total intravenous anesthesia for attenuating secretions in ocular surgery. Medicine (Baltimore) 2017;96:e6729.  Back to cited text no. 3
    
4.
Müller M, Wehrmann T, Eckardt AJ. Prospective evaluation of the routine use of a nasopharyngeal airway (Wendl Tube) during endoscopic propofol-based sedation. Digestion 2014;89:247-52.  Back to cited text no. 4
    
5.
Tseng WC, Lin WL, Cherng CH. Estimation of nares-to-epiglottis distance for selecting an appropriate nasopharyngeal airway. Medicine (Baltimore) 2019;98:e14832.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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