Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

Table 1 Drugs used for awake tracheal intubation in the participants

Drug	Usage and dosage
Penehyclidine hydrochloride injection	0.01 mg/kg, intramuscular injection 30 min before anesthesia
Dexmedetomidine	Intravenous infusion of 0.5 μg/kg for 10 min
Ephedrine hydrochloride	3%, nasal drops
2% lidocaine	3 mL for topical anesthesia of nasal mucosa and nasopharynx; 2 mL for thyrocricocentesis
Compound lidocaine cream	Lubrication on forepart of endotracheal tube and local anesthesia
Fentanyl	1 μg/kg, analgesia, sedation, and inhibition of airway reflex
Midazolam	0.02 mg/kg, sedation and anticonvulsant

Table 2 Demographic data of the patients

Case	Gender	Age (yr)	Height (cm)	Weight (kg)	ASA physical status	Time since AS diagnosis (yr)
1	Male	63	177	70	III	15
2	Male	59	165	72	III	20
3	Male	52	171	68	III	13
4	Male	41	170	48	III	9
5	Male	56	162	51	III	16
6	Male	68	166	61	III	22
7	Male	63	168	59	III	40
8	Male	61	155	45	III	30
9	Male	54	173	60	III	24
10	Male	60	165	55	III	18
11	Female	59	155	47	III	31
12	Male	43	170	81	III	7

ASA: American Society of Anesthesiologists.

Table 3 Preoperative airway assessments

Case	Willson's score	Mallampati classification	Thyromental distance (cm)	Interincisor gap (cm)	Neck mobility (º)
1	6	III	5.5	3.5	< 90
2	5	III	4.5	3	< 90
3	4	III	5.8	3.2	< 90
4	5	III	6	3	< 90
5	5	III	4.3	3	< 90
6	6	III	3.8	2.5	< 90
7	5	IV	4	2.4	< 90
8	5	IV	5	3	< 90
9	5	III	4.8	2.7	< 90
10	5	III	4.5	2.5	< 90
11	6	IV	4.2	2.6	< 90
12	5	III	4.8	2.8	< 90

Table 4 Evaluation during intubation

Case	Preparation time before intubation	Intubation time (min)	Scores of facial grimaces	Airway reactivity score
1	25	3.3	2	2
2	18	2.5	1	1
3	22	3	2	1
4	27	2.7	1	0
5	15	3.1	1	1
6	19	2.6	2	1
7	20	2.2	1	1
8	23	1.9	2	2
9	18	2.1	2	1
10	21	2.6	1	0
11	20	2.8	3	2
12	17	2	2	1

Scores of facial grimace (0 = no grimace: No change in the facial expression; 1 = minimal grimace: A single change in the facial expression; 2 = mild grimace: Grimacing facial expression; 3 = moderate grimace: Severe facial grimace but without reflex head movements; 4 = severe grimace: Severe facial grimace associated with discomforting head movements; and 5 = very severe grimace: Severe facial grimace associated with protective head and limb movements); airway reactivity score (0 = no reactivity; 1 = one cough or gag only; 2 = more than one cough or gag but acceptable conditions; and 3 = unacceptable conditions).

Table 5 Hemodynamic changes

	SBP/mmHg	DBP/mmHg	HR/min
Number of cases	12	12	12
T1	136 ± 18	79 ± 12	87 ± 12
T2	125 ± 13	77 ± 7	78 ± 13
T3	136 ± 16	83 ± 8	92 ± 10
T4	124 ± 10	76 ± 6	78 ± 9
T5	108 ± 11	70 ± 7	67 ± 8

Compared with the values at T1, those at T2-T4 had no statistical difference (P > 0.05), but those at T5 had a significant statistical difference (P < 0.05). Compared with the values at T5, those at T1-T4 had a statistical difference (P < 0.05). SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate.

Table 6 Pulmonary collapse and surgical exposure, and postoperative adverse reactions

Case	Pulmonary collapse and surgical exposure	Epistaxis	Sore throat	Hoarseness	Dysphagia
1	1	1	0	0	0
2	1	0	0	0	0
3	1	0	0	0	0
4	1	1	0	0	0
5	2	1	0	0	0
6	1	0	0	0	0
7	2	0	0	0	0
8	1	1	1	0	0
9	1	0	0	1	0
10	1	1	0	0	0
11	1	1	1	1	0
12	1	1	0	0	0

Pulmonary collapse and surgical exposure (1 = complete collapse with perfect surgical exposure ranked as excellent; 2 = total collapse, but the lung still had residual air; and 3 = no collapse was achieved, or if there was partial collapse with interference in surgical exposure). Postoperative adverse reactions (0 = without; 1 = with).