Mohanta Jharana, Kumar Ajit, Kaushal Ashutosh, Talawar Praveen, Gupta Priyanka, Jain Gaurav
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, M.P., India.
Discoveries (Craiova). 2021 Mar 31;9(1):e125. doi: 10.15190/d.2021.4.
In anticipated difficult airway, awake fiberoptic guided intubation should be the ideal plan of management. It requires sufficient upper airway anesthesia for patient's comfort and cooperation. We compared the efficacy of ultrasound guided airway nerve blocks and ultrasonic nebulisation with lignocaine for airway anesthesia before performing awake fibreoptic guided intubation.
This prospective, randomised study included sixty consenting adult patients of both genders (American Society of Anesthesiologists' physical status 1-3) with anticipated difficult airway undergoing surgery. Ultrasound guided airway nerve blocks group received ultrasound-guided bilateral superior laryngeal (1 ml of 2% lignocaine) and transtracheal recurrent laryngeal (2 ml of 2% lignocaine) airway nerve blocks and ultrasonic nebulisation with lignocaine group received ultrasonic nebulisation of 4 ml of lignocaine 4%. The primary outcome was to compare the time required to intubate, whereas the secondary outcomes were to compare cough reflex and gag reflex, hemodynamic changes, number of attempts required, and comfort score during awake fibreoptic guided intubation in both the groups.
The time taken for intubation was significantly lower in the ultrasound guided airway nerve blocks group 69.27±21.85 s than ultrasonic nebulisation with lignocaine group 92.43 ± 42.90 s (p = 0.015). Hemodynamic variables changed during the procedure but the values were comparable in both groups. There were no statistical differences in cough and gag reflexes, number of attempts, and comfort score in both groups.
This study shows that significant lesser time required for performing awake fiberoptic intubation when patient received ultrasound guided airway nerve block in comparison to ultrasonic nebulisation for airway anaesthesia.
在预期的困难气道处理中，清醒纤维支气管镜引导插管应是理想的处理方案。这需要充分的上气道麻醉以确保患者舒适与配合。我们比较了超声引导气道神经阻滞和利多卡因超声雾化用于清醒纤维支气管镜引导插管前气道麻醉的效果。
这项前瞻性随机研究纳入了60例同意参与的成年患者（美国麻醉医师协会身体状况分级为1-3级），这些患者因预期存在困难气道而需接受手术。超声引导气道神经阻滞组接受超声引导下双侧喉上神经阻滞（2%利多卡因1 ml）和经气管喉返神经阻滞（2%利多卡因2 ml），利多卡因超声雾化组接受4%利多卡因4 ml的超声雾化。主要结局是比较插管所需时间，次要结局是比较两组在清醒纤维支气管镜引导插管过程中的咳嗽反射和 gag 反射、血流动力学变化、所需尝试次数及舒适度评分。
超声引导气道神经阻滞组的插管时间显著低于利多卡因超声雾化组，分别为69.27±21.85秒和92.43±42.90秒（p = 0.015）。术中血流动力学变量发生了变化，但两组的值具有可比性。两组在咳嗽和 gag 反射、尝试次数及舒适度评分方面无统计学差异。
本研究表明，与利多卡因超声雾化用于气道麻醉相比，患者接受超声引导气道神经阻滞时，清醒纤维支气管镜插管所需时间显著缩短。
