Airway Blocks Vs LA Nebulization- An interventional trial for Awake Fiberoptic Bronchoscope assisted Nasotracheal Intubation in Oral Malignancies

Abstract

Background: Patients with intra-oral malignancies warrants use of awake Fiberoptic assisted naso-thracheal intubation to secure an airway due to multiple risk factors leading to anticipated difficult airway. Different techniques such as airway blocks, local anesthesia (LA) gargles, spray, nebulization and mild sedation are in practice to improve the success rate of fiberoptic assisted intubation. Methods: Sixty patients of ASA I and II with Mallampatti score 3 and above, posted for Commando operations were enrolled in this study and were divided into 2 groups. Group AB (Airway Block, n=30) were given Superior laryngeal nerve block bilaterally and recurrent laryngeal nerve block transtracheally with Inj 2% Lignocaine. Second Group AN (Airway Nebulization, n=30) patients airway was nebulized with 4% Lignocaine with ultrasonic nebulizer. After confirmation of satisfactory anesthesia clinically Fiber-optic assisted naso-tracheal intubation was attempted. Hemodynamic monitoring, total time taken for intubation, patients comfort and any complications occurred were noted. Statistical Analysis– All the observed values were tabulated and analyzed using software SPSS version 17.0. Results: Demography and Hemodynamic observations were comparable in the groups. The time taken for intubation, patient comfort score, intubation conditions were excellent in AB group than in group AN. Airway complications like laryngospasm and cough were noted in AN Group. Conclusions: Judicial use of combined Airway blocks such as Bilateral Superior and trans-tracheal recurrent laryngeal nerve blocks could facilitate a successful fiber-optic assisted awake naso-tracheal intubation in anticipated difficult intubation with negligible complications.

Anesthetic management of airway stent placement by rigid bronchoscopy with superior laryngeal nerve block while preserving spontaneous breathing: A case report

“…SLNB is often used in awake intubation, similar to rigid bronchoscopy. SLNB in awake fiber intubation is more advantageous than the spray method alone, in terms of the time required for intubation and patient satisfaction 7 , 8 . In the case of awake fiber intubation, similar results were obtained in patients treated with SLNB and patients treated with continuous remifentanil alone 9 .…”

Comparison of modified anterior and traditional posterior accesses for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: study protocol for a randomised non-inferiority clinical trial

“…For decades, findings have indicated that a method that consists of SLNB along with TLI can provide satisfactory anaesthesia and intubating conditions, compared with those with topical anaesthesia and TLI. 3 4 …”

“…Superior laryngeal nerve block (SLNB) can effectively abolish the glottic closure reflex, and blunt the sensation of the structures above the cords. For decades, findings have indicated that a method that consists of SLNB along with TLI can provide satisfactory anaesthesia and intubating conditions, compared with those with topical anaesthesia and TLI 3 4…”

A spray-as-you-go airway topical anesthesia attenuates cardiovascular responses for double-lumen tube tracheal intubation

“…Therefore, SLN block combined with transtracheal topical anesthesia can effectively inhibit the strong stress response in the throat and trachea caused by tracheal intubation. The anesthetic effect of this method has been demonstrated during conscious intubation [ 10 ]. Ultrasound-guided nerve block and TTI increase the success rate of nerve block and puncture and improve the reliability of the anesthesia [ 11 , 12 ].…”