Transtracheal lidocaine: An alternative to intraoperative propofol infusion when muscle relaxants are not used

Abstract

Background:Facial nerve monitoring, often required during total parotidectomy, precludes use of long acting muscle relaxants and propofol infusion is used solely to ensure patient immobility. We aimed to compare intraoperative patient immobility, hemodynamic stability and propofol consumption during total parotidectomy following a transtracheal block.Material and Methods:Forty patients were allocated to 2 equal groups. Preoperatively, group A patients received transtracheal block with 4 ml of 4% lidocaine, while no block was given to patients in group B. If there was patient movement, tachycardia or hypertension, group A patients received a bolus of propofol 30 mg and propofol infusion was started (100mg/hr). In group B, propofol infusion was started (100mg/hr) soon after intubation.Result:Both group A and B were comparable with respect to patient immobility and hemodynamic stability. There was no intraoperative propofol requirement in group A.Conclusion:Transtracheal block is a safe and successful alternative to propofol infusion during surgeries where muscle relaxants are to be avoided.

Effectiveness of transtracheal lidocaine as an adjunct to general anesthesia in providing patient immobility during total parotidectomy: A comparison with dexmedetomidine infusion

“…[23] Though there are many techniques to block the superior laryngeal nerve, transtracheal block is the commonly administered airway block as it is technically easy, requires only a small dose of local anesthetic, and provides reliable anesthesia. Transtracheal block has many applications.…”

“…Anesthetizing the larynx and trachea blocks the sensory stimuli arising from the larynx and trachea due to the presence of endotracheal tube and thereby reduces the depth of anesthesia required to ensure immobility intraoperatively. [ 2 3 ] Though there are many techniques to block the superior laryngeal nerve, transtracheal block is the commonly administered airway block as it is technically easy, requires only a small dose of local anesthetic, and provides reliable anesthesia. Transtracheal block has many applications.…”

“…It provides stable vitals, good conditions for bronchoscopists, and is not associated with any major complications or patient discomfort, when given for diagnostic bronchoscopies. [ 4 ] It has been successfully used as an adjunct to general anesthesia during total parotidectomy[ 2 ] as well as brachial plexus surgeries[ 3 ] to ensure patient immobility in the absence of muscle relaxants.…”

“…Transtracheal block has been suggested as an alternative to propofol infusion to provide patient immobility without hemodynamic instability during total parotidectomy. [ 2 ]…”

Role of electromyography endotracheal tube in preventing recurrent laryngeal nerve injury during thyroid surgery: A case report

“…When muscle relaxants are not used, a deeper plane of anaesthesia is required to prevent spontaneous movement of vocal cords. [ 10 ] We achieved this by keeping entropy between 40 and 60 using a combination of sevoflurane, propofol and dexmedetomidine. This ensured that spontaneous vocal cord movements were curbed but an evoked response was possible.…”