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Category: Volume 06 Issue 03 March 2018
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Title: A comparative evaluation of three different methods used to achieve local anaesthesia for fiberoptic guided intubation under sedation

Authors: Naresh Kumar Sharma, Kiwi Mantan, Sangeeta Sethia, Sadhana Jain, Vishal Devra

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.211

Abstract

Background and Aim: Fiberoptic intubation is the gold standard technique for airway management in patients with difficult standard direct laryngoscopy, performed either awake or under sedation. The aim of sedation is to facilitate patient comfort and satisfaction, and to alleviate patient anxiety. Aim of this prospective randomized comparative study was to compare three different methods of topical anaesthesia under sedation, namely transcricoid injection, spray as you go, nebulisation of lignocaine with respect to intubation grading scale, severity scale, intubation time and complications in patients undergoing intubation.

Methodology: Ninety ASA grade 1 or 2 patients of either sex aged 20-50 yrs scheduled for elective surgery were equally divided into three groups(n=30), received 0.1% xylometazoline in both nostrils then 10% lignocaine by spraying the nares and posterior pharyngeal wall. Thereafter patients received 4ml of 4% lignocaine either by trancscricoid injection in group A, or via spray as you go method in group B, or via nebulization 15 min prior to procedure in group C. Intubation time, intubation grading scale, grading of overall intubating condition, cough counts, stridor, extra local anaesthetic requirement and were recorded. Patients were asked to score the procedure using severity score. Patients were monitored continuously for vital parameters blood pressure, SpO2, ECG, pulse rate.

Results: Group A patients showed better severity scale (p<0.01), shorter intubation time, lower incidence of coughing and stridor, didnot require extra dose of local anaesthetic and were maintained PR, BP, SpO2. The endoscopist intubation grading scale and grading of overall intubating conditions were better in Group A (p<0.01) than Group B&C.

Conclusion: In conclusion transcricoid injection of local anaesthetic was safe, providing effective local anaesthesia and was preferred by both patient and endoscopist.

Keywords: Fiberoptic intubation, lignocaine.

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Corresponding Author

Naresh Kumar Sharma

Resident, Department of Anaesthesia, Sardar Patel Medical College & AGH, Bikaner, Rajasthan

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