Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha,

doi:10.4103/1658-354x.144056

Cited by 38 publications

(28 citation statements)

References 10 publications

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“…Several other researchers also have used cough and gag reflexes as a tool to study the efficiency of topical anaesthesia. [ 4 5 6 ] Regional block was considered adequate if there was no event of cough or gag during the procedure and was considered the best with a score of 1. Need for rescue topical anaesthesia spray was considered as the worst in the efficiency of the topical anaesthesia with a score of 5.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

et al. 2017

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Background and Aims:Successful awake fibreoptic intubation (AFOI) depends on adequate topical anaesthesia of the airway. We aimed to compare efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for AFOI.Methods:It was a prospective, randomised controlled study of 33 patients with the American Society of Anesthesiologists’ physical status 1–3 with anticipated difficult airway requiring AFOI. The primary objective was to compare the patient comfort after topical anaesthesia of the airway using atomiser with transtracheal injection of the local anaesthetic agent for AFOI in patients with anticipated difficult airway. The secondary objectives were to compare the ease of intubation, time required to intubate and the haemodynamic changes during intubation. After topical anaesthesia of nostrils, patients in Group T received transtracheal injection of 4 ml of 4% lignocaine whereas Group A patients received 4-5mL of 4% atomised lignocaine using DeVilbiss atomiser before AFOI. Patient comfort assessed objectively by the anaesthetic assistant during the procedure, ease of intubation assessed using cough and gag reflex score, time taken to intubate and the haemodynamic changes during the procedure were compared.Results:Ease of intubation, patient comfort and the time taken to intubate were significantly better in Group T patients, with P = 0.001, 0.009 and 0.019, respectively, compared with the patients in Group A. There were no significant changes in haemodynamic parameters.Conclusion:Topical anaesthesia by transtracheal injection in patients with anticipated difficult airway made AFOI easier and faster with better patient comfort compared to atomiser with no clinically significant untoward side effects.

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Section: Discussionmentioning

confidence: 99%

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

et al. 2017

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“…Gupta et al . [ 9 ] in 2014 conducted study on 50 patients with cervical spine injury allocated in two groups one receiving airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and other receiving airway nerve blocks (bilateral superior laryngeal, transtracheal, and recurrent laryngeal nerve). Nerve block group showed less time taken for intubation, less number of coughing/gagging episodes, more vocal cord visibility and more ease of intubation and less use of extra LA as compared to the nebulized group.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

et al. 2016

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Aims of Study:To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks.Materials and Methods:In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine.Results:Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades.Discussion:The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique.Conclusion:A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.

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“…Airway blocks provide good airway anesthesia to facilitate the performance of awake FOB intubation (Gupta et al . [ 2 ]).…”

Section: Discussionmentioning

confidence: 99%

“…Gupta et al .,[ 2 ] in 2014, showed better patient comfort in the nerve block group as compared to the nebulization group. Vocal cord visibility and ease of intubation were also better in nerve block group as compared to the nebulization group.…”

Section: Discussionmentioning

confidence: 99%

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Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

et al. 2018

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Context:Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI.Aim:This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI.Methodology:This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis.Results:Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB.Conclusion:Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

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Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

Cited by 38 publications

References 10 publications

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

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