Experience of awake fiberoptic intubation in patients treated for Ludwig’s angina

Abstract

Background and Goal of Study: Patients treated for the mouth floor cellulitis (Ludwig's angina) are presented for anesthesia with a known or anticipated difficult airway which is often managed by performing awake tracheal intubation. The goal of study was to analyze the experience of awake fiberoptic intubation (FOI) and to compare the results with demographic data. Materials and Methods: A prospective questionnaire study was carried out in Lithuanian University of Health Science in the period of February 2014 to November 2014. After the identification in the anesthesia database 31 patient with Ludwig's angina who had undergone awake FOI with standard topical anesthesia and sedation, was at least 16 years old and had written informed consent was included. Patients' demographics were evaluated from clinical records. Subjects completed an anonymous questionnaire during the hospitalization about side-effects of FOI. Nonparametric tests were used for statistical analysis at p ≤ 0.05. Results and Discussion: The mean age of patients was 45.74+/-18.642, median 43, mode 31, min 17, max 79 years. The male-female ratio was 2.88:1. Female gender was related to dryness (χ²=8.88, p=0.003), hoarseness (χ²=5.135, p=0.023), usage of rescue analgesia (χ²=5.862, p=0.015) after FOI. 8 (26%) of patients have completed basic, 19 (61%) secondary, 4 (13%) tertiary education. History of cigarette smoking (17 pat., 55%, n=31), chronic lung disease (2 pat., 6.5%, n=31) was related to rhinorrhea after FOI (χ²=7.33, p=0.007, χ²=7.33, p=0.007 respectively). 27 (87.1%) of patients said they had enough information about FOI. Patients (n=31) described the procedure as: unpleasant (20, 64.5%), painful (4, 12.9%), very painful (1, 3.2%), neutral (1, 3.2%), did not remember (5, 16.1%). The data about the experience of FOI is similar to the findings of other researchers.1 It is important to pay attention to the patient's gender, smoking s