Awake Fiberoptic Intubation: Comparison Of Three Techniques of Spray-As-You-Go.

ABSTRACT

Background: Awake fiberoptic intubation is the gold standard technique for the management of the predicted difficult airway. The patient’s tolerance and the success of fiberoptic-assisted nasotracheal intubation depends on the effectiveness of topical anaesthesia. Aim of this prospective randomized comparative study was to compare three techniques of spray-as-you-go using topical anaesthesia, namely lignocaine injected through working channel, epidural cathether and angiographic cathether taking into consideration - severity scale, patient reaction score, intubation time, total dose of lignocaine and complications in patients during intubation. Methods: Sixty ASA 1 or 2 patients of either sex aged 18-60 yrs scheduled for elective surgery with predicted difficult airway were equally divided into three groups(n=20),received 0.1% xylometazoline in both nostrils and 10% lignocaine sprayed into nares and posterior pharyngeal wall. Thereafter patients received 6ml of 4% lignocaine in four aliquots either by working channel in group A, or via epidural catheter in group B, or via angiographic catheter in group C along with oxygen attached through three way tap proximally. Intubation time, reaction score, cough count, stridor, extra local anaesthetic requirement, severity score were recorded. Vital parameters blood pressure, SpO2, ECG, pulse rate were monitored. Results: Group A patients showed shorter intubation time (p<0.0005) with better severity score and less local anaesthetic requirement maintaining stable vital parameters with lower incidence of cough. Reaction score was better in group A than Group B & C. Conclusion: In conclusion spraying directly through the working channel along with oxygen provided effective local anaesthesia and was preferred by both patient and endoscopist.