Korean J Anesthesiol.  2018 Apr;71(2):120-126. 10.4097/kjae.2018.71.2.120.

Comparison between lignocaine nebulization and airway nerve block for awake fiberoptic bronchoscopy-guided nasotracheal intubation: a single-blind randomized prospective study

• Mathur PR
• Jain N
• Kumar A
• Thada B
• Mathur V
• Garg D

• KMID: 2411219
• DOI: http://doi.org/10.4097/kjae.2018.71.2.120

Abstract

BACKGROUND
The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation.
METHODS
Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups. Group N received jet nebulization (10 ml of 4% lignocaine) and Group B received bilateral superior laryngeal and transtracheal recurrent laryngeal nerve blocks (each with 2 ml of 2% lignocaine) followed by fiberoptic bronchoscopy-guided nasotracheal intubation. All patients received procedural sedation with dexmedetomidine. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student's t test was used to analyze parametric data, while the Mann-Whitney U test was applied to non-parametric data and Fisher's test to categorical data. P values < 0.05 were considered statistically significant.
RESULTS
The time taken for intubation was significantly shorter in Group B [115.2 (14.7) s compared with Group N [214.0 (22.2) s] (P = 0.029). The intubating conditions and degree of patient comfort were better in Group B compared with Group N. Although all patients were successfully intubated, patient satisfaction was higher in Group B.
CONCLUSIONS
Airway nerve blocks are preferable to lignocaine nebulization as they provide superior-quality airway anesthesia. However, nebulization may be a suitable alternative when a nerve block is not feasible.

Keyword

Airway management; Dexmedetomidine; Intubation; Lignocaine; Nebulizers; Nerve block

MeSH Terms

Adult
Airway Management
Anesthesia
Anesthesia, General
Cough
Dexmedetomidine
Humans
Intubation*
Lidocaine*
Nebulizers and Vaporizers
Nerve Block*
Patient Satisfaction
Prospective Studies*
Recurrent Laryngeal Nerve
Vocal Cords
Dexmedetomidine
Lidocaine