Spray-As-You-Go Airway Topical Anesthesia in Patients with a Difficult Airway: A Randomized, Double-Blind Comparison of 2% and 4% Lidocaine

Abstract

Both 2% and 4% lidocaine administered topically by a spray-as-you-go technique can provide clinically acceptable intubating conditions for awake FOI in sedated patients with a difficult airway. As compared with 4% lidocaine, however, 2% lidocaine requires a smaller dosage and results in lower plasma concentrations.

Nebulisation Versus Spray-as-You-Go Airway Topical Anaesthesia in Patients with Temporomandibular Joint Ankylosis using 2 % Lignocaine

“…In both groups, however, MAP and HR observed during airway manipulation were comparable. Also, they improved rapidly to basal values after intubation, in consonance with previous studies [4,9,10]. These slight cardiovascular responses may be ascribed to tracheal stimulation caused by the insertion of the FOB and endotracheal tube [4].…”

“…Also, they improved rapidly to basal values after intubation, in consonance with previous studies [4,9,10]. These slight cardiovascular responses may be ascribed to tracheal stimulation caused by the insertion of the FOB and endotracheal tube [4]. There is increasing evidence to suggest that tracheal stimulation is the primary cause of the cardiovascular response [13] and effective airway topical anaesthesia can completely block these adverse responses [4,7,14].…”

“…Numerous combinations of analgesics, amnesics [4,12] and airway topical anaesthesia have been used for awake nasotracheal intubation. The primary aim of this study was to determine differences in the efficacy of airway topical anaesthesia between 2 % lignocaine nebulisation and 2 % lignocaine via spray-as-you-go technique for AFOI.…”

“…These slight cardiovascular responses may be ascribed to tracheal stimulation caused by the insertion of the FOB and endotracheal tube [4]. There is increasing evidence to suggest that tracheal stimulation is the primary cause of the cardiovascular response [13] and effective airway topical anaesthesia can completely block these adverse responses [4,7,14]. The absence of significant differences in the haemodynamic responses between the two groups during AFOI advocates that 2 % lignocaine nebulisation and 2 % lignocaine via spray-as-you-go technique are equally effective for AFOI [4].…”

“…General anaesthesia and nasotracheal intubation are the main problems of surgery in TMJ ankylosis because it is difficult to intubate the patient of TMJ ankylosis as the laryngeal inlet is not visible [1,2]. Awake intubation is the technique most commonly chosen in patients with a difficult airway [3] but gag reflex, cough, and laryngospasm can be upsetting during the process [4]. Awake patients never permit airway instrumentation without airway anaesthesia.…”