title: Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer.
abstract: BACKGROUND
  Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks.
  
  
  METHODS
  A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted.
  
  
  RESULTS
  The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L.
  
  
  CONCLUSIONS
  Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate.
authors.affiliation: Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Santvana
authors.initials: S
authors.lastname: Kohli
authors.affiliation: Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kamran
authors.initials: K
authors.lastname: Farooque
authors.affiliation: Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gopal
authors.initials: G
authors.lastname: Jalwal
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Chandralekha
keywords: Airway management; bronchoscopy; laryngeal nerves; lidocaine; nebulizers