title: The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation.
abstract: OBJECTIVE
  To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks.
  
  
  METHODS
  In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I-II, Mallampati Grade I-IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine.
  
  
  RESULTS
  Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades.
  
  
  CONCLUSIONS
  The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique.
  
  
  CONCLUSIONS
  A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Chatrath
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.forename: Radhe
authors.initials: R
authors.lastname: Sharan
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.forename: Payal
authors.initials: P
authors.lastname: Jain
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Bala
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.lastname: Ranjana
authors.affiliation: Department of Anaesthesia and ICU, Government Medical College, Amritsar, Punjab, India.
authors.lastname: Sudha
keywords: Awake; difficult airway; fibreoptic; local anesthesia; nerve blocks