COMPARISON OF ‘AIRWAY NERVE BLOCK’ VS ‘SPRAY-AS-YOU-GO’ METHOD USED FOR AWAKE FLEXIBLE BRONCHOSCOPIC INTUBATION IN COMBINATION WITH CONSCIOUS SEDATION – A PROSPECTIVE, RANDOMISED, SINGLE BLIND STUDY

Abstract

Introduction: Fibreoptic Intubation (FOI) is the gold standard for managing difcult airways. There are various approaches such as: Nebulization with lidocaine; 'Spray as you go'(SAYGO); Airway nerve block - blocking superior laryngeal nerve & recurrent laryngeal nerve & sedation. The present study aims to compare 'airway nerve block' (NB) and 'spray as you go'(SA) method for awake exible bronchoscopic intubation used in combination with conscious sedation. Methods: 60 patients of age group 18 – 65 years with difcult airway undergoing general anaesthesia with nasotracheal intubation, were randomly allocated into two groups. After premedication & nasal preparation, all patients received injection dexmedetomidine at a dose of 1µg/kg in 100ml of 0.9% NS over 10 minutes. In Group SA, 2ml lignocaine 4% was sprayed above and below the cords after visibility of glottic opening via working channel of the bronchoscope and 2 ml lignocaine 4% within trachea before insertion of endotracheal tube. In Group NB, bilateral superior laryngeal nerves & recurrent laryngeal nerve was blocked. Then a exible breoptic bronchoscope preloaded with a exometallic endotracheal tube of appropriate size was then inserted via nasal route. Results: The mean intubation time for Group NB [87.27 ± 7.58 sec] was shorter than that for Group SA [190.33 ± 9.14] (p<0.0001). Conclusion: Awake exible bronchoscopic intubation under sedation with airway nerve block provides better intubating conditions compared to SAYGO