Pharmacological combination for awake tracheal intubation in patients with giant struma: A case report
Abstract
The principle of general anesthesia is a free airway during anesthesia-surgery. A female patient age 55 year, who has morbid obesity with body mass index/BMI 38.6, and suffered from hypertension, diabetes mellitus, and giant struma was having struma-lifting surgery in Melinda 2 Hospital Bandung-Indonesia. The patient was assumed to have difficulties in performing intubation, therefore it was decided to do awake tracheal intubation (ATI) for the general anesthesia facility. Patient was positioned in a Ramped position, she was given monitor standard, was given binasal oxygen, and several medicine which combination of lidocaine spray, lidocaine, fentanyl, midazolam, and dexmedetomidine intravenous. Intubation was done with direct laryngoscopy. After the endotracheal tube (ETT) was entered, which was confirmed by the balloon movement of the anesthesia machine, the patient was given propofol, additional fentanyl, and muscle paralyzed atracurium and dexmedetomidine was stopped. Anesthesia maintenance was N2O/O2, sevoflurane. Bleeding amount was 1200 mL and the fluid given was ringer laktat 1000 mL and gelofusin 1000 mL. During the surgery there was severely decreasing blood tension which needed efedrin, then it was replaced with norepinefrin bitartrate monohydrate (vascon) and finally the combination of vascon and dobutamine. At the end of the surgery, after the patient could open her eyes, spontaneous respiration and extubation were given. The post-surgery patient then was taken care of in a high-care unit for four days before she was moved to the ward.
Keywords: Awake tracheal intubation, Giant struma, Morbid obes, Hypertension, Difficult airway, Severe hypotension
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