Sandip Sinha1, Soma Chakraborty2, Abhinandan Mondal3, Md. Enayet Shaik4, Barnali Ghosh5, Diptimay Majumder6
BACKGROUND Anaesthesia for flexible fibre-optic bronchoscope guided awake intubation of the trachea can be achieved by nebulization with local anaesthetic, airway nerve blocks or by atomization with local anaesthetic. METHODS A prospective, randomized, open label study was conducted on 63 patients, divided into three groups, Group A (Nebulisation), Group B (Airway Nerve Block), Group C (Atomization). Time for intubation, ease of intubation, cord visibility, grade of intubating condition, patients comfort score and vital parameters were recorded. RESULTS Group A patients had more increase in hemodynamic variables than Group B and Group C. More time was spent for intubation in Group A. Group B had best cough & gag scores among all groups. Patients of group B were the most comfortable with nearly 90% of them having comfort scores 1 or 2. Group B patients had the most optimal intubating condition grading with 66.6% having optimal grades. The best cord visibility and most relaxed vocal cords were observed in group B patients. CONCLUSIONS Airway nerve blocks provide more adequate airway anaesthesia in respect of cough and gag scores, comfort score, cord visibility, intubating condition grade and hemodynamic condition to aid in awake FOB guided intubation than atomization and nebulization with local anaesthetics. Atomization technique also provides more hemodynamic stability, less cough and gag score, greater comfort score and good intubating condition than nebulization technique.
