Abstract
Background
Unanticipated difficult airway during anesthesia induction, especially in the circumstance of cannot intubate, cannot ventilate, could be harmful to patients. Rapid reversal of patients to adequate spontaneous ventilation is a reasonable goal. We are committed to studying reversible induction strategies, which can be safe and feasible in the case of difficult airway during anesthesia induction, especially before intubation and ventilation failure.
Methods
High-flow oxygen inhalation (40 l·minute− 1) and FiO2 (100%) were administered preoperatively for five minutes. During anesthesia induction, target controlled infusion was performed with remifentanil 4 ng·ml− 1 and propofol 4 µg·ml− 1, and rocuronium 0.6 mg·kg− 1 was injected intravenously. Subsequently, the oxygen flow was adjusted to 60 l·minute− 1, with the patients’ jaws lifted after the patients had lost consciousness. A direct laryngoscope was used for laryngoscopy and grading. The tracheas of patients with Cormack–Lehane (CL) grade I–II were intubated directly. For the patients with CL grade III–IV, sugammadex (16 mg·kg− 1) was administered and TCI was stopped. Then conscious intubation was performed after the patients were fully awake. The primary outcome was the rate of reversion success within 15 minutes from induction.
Results
In total, 20 patients with CL grade 3–4 undergoing elective surgery needed reversion. The reversion success rate was 100%. The shortest time to reversion was 333 s, the longest was 900 s, and the median time was 455 s. During the whole procedure, no hypoxia occurred, and acceptable hypercapnia appeared.
Conclusions
The results of this study suggest that a rapid reversible induction strategy is safe and easy to perform. Prompt reversal to spontaneous ventilation should be an option for unanticipated difficult airway before cannot intubate, cannot ventilate occurs.
Trial registration
This study was registered on ClinicalTrials.gov (NCT04434963) on 17th June 2020.