To Compare the Efficacy of Local Anaesthetic Administration via Spray as you Go Technique and Ultrasonic Nebulisation for Awake Fiberoptic Intubation

Abstract

Introduction: Awake fiberoptic intubation using local anaesthetics is the most dependable procedure to secure a difficult airway. It is electively done under various techniques of local anaesthesia which include administration of local anaesthetic via nebulisation, airway blocks and spray as you go with or without sedation. Aim: To compare the efficacy of nebulisation with 4% lignocaine versus spray as you go technique for awake fiberoptic intubation. Materials and Methods: Sixty patients of American Society of Anesthesiologists (ASA) grade I-III were randomly divided into two groups (group N and group S). Patients in group N were nebulised with 4mL of 4% lignocaine while group S patients received four aliquots of 1mL 4% lignocaine through the working channel of the fiberoptic bronchoscope. The patients were compared for haemodynamic parameters, intubating conditions, intubation attempts, time taken for intubation and patient satisfaction score. The results were statistically analysed using SPSS version 22.0 software and compared. Results: On comparing the intubating conditions, the patients in group S showed better intubation score than the patients in group N (p-value <0.004). The time taken for intubation was lesser (4.56±0.85 minutes in group S and 4.0±0.45 minutes in group N) and the patient satisfaction score was also better in the spray as you go group. Conclusion: Spray as you go technique offers more effective local anaesthesia and better patient satisfaction as compared to nebulisation for awake fiberoptic intubation.

Keywords

• anaesthesia
• bronchoscopy
• fiberoptic technology
• intubation
• lignocaine
• local
• patient satisfaction