Role of Lignocaine Nebulization As an Adjunct to Airway Blocks for Awake Fiber-Optic Intubation: A Comparative Study

Context: Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI.

Aim: This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI.

Methodology: This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1-2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired -test were used for statistical analysis.

Results: Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB.

Conclusion: Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.