Background Spray-as-you-go (SAYGo) airway topical anesthesia and nerve block are common techniques used during awake tracheal intubation. However, their effects have not been described during double-lumen tube intubation. We report on a prospective randomized study that aimed to compare the intubation effects of SAYGo and nerve block patients undergoing thoracic surgery. Methods Sixty-six American Society of Anesthesiologists (ASA) physical status I and II patients were scheduled to undergo double-lumen tube (DLT) tracheal intubation for thoracic surgery. The patients were randomly assigned into control (Group C), ultrasound (Group U), and flexible intubation scope (Group F) groups with 22 cases in each group. Patients in Group C were induced with a standard anesthetic regimen. Patients in Groups U and F were treated with superior laryngeal nerve (SLN) block combined with transtracheal injection (TTI) and given a SAYGo airway topical anesthesia before intubation. Hemodynamic variables during intubation process were recorded as the primary outcome. Additional patient data were recorded including the occurrence of adverse events, the level of hoarseness, the occurrence of sore throats, memory function and the level of patient satisfaction with anesthesia. Results The blood pressure (BP) and heart rate (HR) of patients in group C was significantly increased 1 min after tracheal intubation (P < 0.05) compared to before anesthesia. The BP and HR of patients in Groups U and F remained stable. 10 cases of hypertension were observed in Group C, 6 cases in Group U and 1 case in Group F. In Group C, tachycardia was observed in 9 patients along with 9 cases in Group U and 4 cases in Group F. In Group U, 4 patients experienced puncture and bleeding were and 8 patients had a poor memory of TTI. No significant differences were found in the incidence of hoarseness, sore throats, and satisfaction with anesthesia in postoperative follow-up. Conclusions SAYGo airway topical anesthesia and SLN block combined with the TTI technique can inhibit the cardiovascular response during DLT tracheal intubation. The SAYGo technique has fewer complications and more advantages compared to other approaches.

Background: The spray-as-you-go airway topical anesthesia and nerve block technique are commonly used in awake tracheal intubation. However, their effects have not been described for double-lumen tube intubation. A prospective randomized study was designed to compare their intubation effects in thoracic surgery patients. Methods: Sixty-six ASA physical status I and II patients were scheduled to undergo double-lumen tube(DLT) tracheal intubation for thoracic surgery. They were randomly assigned into control (Group C), ultrasound (Group U), and flexible intubation scope (Group F) groups with 22 cases in each group. Patients in Group C were induced with a standard anesthetic regimen. Patients in Group U and Group F were treated with superior laryngeal nerve(SLN) block combined with transtracheal injection and given a spray-as-you-go airway topical anesthesia respectively before intubation. Hemodynamic variables during intubation were recorded. Additional patient data were recorded including the occurrence of adverse events, the level of hoarseness, the occurrence of sore throat, memory function and the level of patient satisfaction with anesthesia. Results: The blood pressure and heart rate of patients in group C significantly increased 1 min after tracheal intubation (P<0.05) compared to before anesthesia yet the blood pressure and heart rate of patients in Groups U and F remained stable. During observation, there were 10 cases of hypertension in Group C, 6 cases in Group U and 1 case in Group F. In Group C, tachycardia was observed in 9 patients along with 9 cases in Group U and 4 cases in Group F. In Group U, 4 patients experienced puncture and bleeding were and 8 patients had a poor memory of transtracheal injection. No significant differences were found in the incidence of hoarseness, sore throat, and satisfaction with anesthesia in postoperative follow-up. Conclusions: Spray-as-you-go airway topical anesthesia and SLN block combined with transtracheal injection technique can inhibit the cardiovascular response during DLT tracheal intubation. The spray-as-you-go technique has fewer complications and more advantages compared to other approaches.