Department of Anesthesia, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
Chin Med J (Engl). 2011 Dec;124(23):3997-4001.
Difficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.
Thirty adult patients referred for elective surgery under general anesthesia, aged 18 - C60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg), propofol (2 mg×kg(-1)×h(-1)) and remifentanil (0.05 µg×kg(-1)×min(-1)). Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation.
All patients were intubated at the first attempt, the average intubation condition score was 7.0 ± 1.1, from 6 to 10, satisfied intubation condition. MAP and HR increased significantly but mildly immediately after the tracheal intubation (P < 0.05), and decreased to the pre-intubation level soon after intubation. There were no related complications and patients had no recall of the intubation procedures.
Topical anesthesia with pressure driven 2% lidocaine spray, where pressure is achieved by 10 L/min oxygen flow, can offer satisfactory intubation conditions for conscious sedation intubation.
困难气道不仅对麻醉医生来说是一个挑战，也是患者面临的生命威胁。清醒插管是处理困难气道的主要选择，清醒插管的关键是气道局部麻醉。然而，到目前为止，还没有理想的清醒插管局部麻醉方法。本研究旨在评估压力驱动（10 L/min 氧气流量）利多卡因喷雾对气道局部麻醉的效果，以寻找一种用于清醒镇静插管的强力便捷的气道局部麻醉方法。
选择 30 例拟全身麻醉下择期手术患者，年龄 18-60 岁，Mallampati 分级 I 或 II 级。在局部麻醉前，通过静脉注射咪达唑仑（0.03 mg/kg）、异丙酚（2 mg/kg·h）和瑞芬太尼（0.05 μg/kg·min）将观察者评估的警觉和镇静评分（OAA/S）控制在 3-4 分之间。镇静 10 分钟后，采用压力驱动利多卡因喷雾进行局部麻醉；驱动压力由 10 L/min 的氧气流量产生。局部麻醉后，进行气管插管，并由有经验的麻醉医生采用改良的 Erhan 插管条件评分评估插管条件，评分<10 为满意。记录患者插管尝试次数，并记录局部麻醉毒性、黏膜损伤和呼吸抑制等并发症。记录插管前后不同时间点的平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2）。术后 24 小时询问患者是否能回忆起插管期间的事件。
所有患者均一次插管成功，平均插管条件评分为 7.0±1.1，从 6 分到 10 分，插管条件满意。气管插管后即刻 MAP 和 HR 明显但轻度升高（P<0.05），插管后很快降至插管前水平。无相关并发症，患者对插管过程无记忆。
采用压力驱动 2%利多卡因喷雾（压力由 10 L/min 氧气流量产生）进行局部麻醉，可提供清醒镇静插管的满意插管条件。
