Sitzman B T, Rich G F, Rockwell J J, Leisure G S, Durieux M E, DiFazio C A
Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Anesthesiology. 1997 Jan;86(1):34-40. doi: 10.1097/00000542-199701000-00006.
Glossopharyngeal nerve (GPN) blocks may provide reliable analgesia for awake direct laryngoscopy, although this has not been evaluated prospectively. This study was designed to determine if GPN blocks provide a superior route of local anesthetic administration for awake direct laryngoscopy as measured by hemodynamic, gag, and subjective pain responses.
A prospective, randomized, single-blinded, crossover design was used. All participants (n = 11) were anesthesiologists. Three routes of local anesthetic administration were evaluated: 2 min of 2% viscous lidocaine swish and gargle (S&G); S&G combined with 10% lidocaine spray (S&G/spray); and S&G combined with 1% lidocaine bilateral GPN blocks (S&G/block; anterior tonsillar pillar method). Five minutes after the local anesthetic was administered, laryngoscopy was performed and sustained for 20 s. Noninvasive hemodynamic measurements and serum lidocaine concentrations were determined. Visual analogue scale scores and a poststudy questionnaire were used to assess participants' ability to tolerate local anesthetic administration and laryngoscopy and their choice for use in clinical practice.
No significant hemodynamic changes were observed, although there was a modest increase (< 15%) in heart rate in the S&G/block group in the first minute after laryngoscopy. Serum lidocaine concentrations were higher (P < 0.05) in the S&G/block group at 5 and 10 min (0.5 +/- 0.1 and 1.0 +/- 0.2 microgram/ml) compared with the S&G group. Participants' visual analogue scale scores, which assessed their ability to tolerate laryngoscopy, showed that S&G (5.4 +/- 0.9) resulted in more discomfort (P < 0.05) than either S&G/spray (3.5 +/- 0.9) or S&G/block (3.3 +/- 0.7). The laryngoscopist's visual analogue scale scores, which assessed the ease of visualization, revealed a trend (P < 0.08) toward less coughing and gagging with S&G/spray (1.8 +/- 0.9) compared with S&G (4.0 +/- 1.3) and S&G/block (3.7 +/- 1.1). Oropharyngeal discomfort lasting 24 h or more was reported by 91% of participants after S&G/block, whereas no participant reported oropharyngeal discomfort after S&G or S&G/spray. Significantly more participants (73%) indicated their preference for using S&G/spray in future clinical practice compared with S&G (P < 0.01) and S&G/block (P < 0.05).
Glossopharyngeal nerve blocks do not provide a superior route of local anesthetic administration for awake direct laryngoscopy. Two minutes of 2% viscous lidocaine S&G followed by 10% lidocaine spray was the anesthetic route preferred by participants and laryngoscopists.
舌咽神经（GPN）阻滞可为清醒直接喉镜检查提供可靠的镇痛效果，尽管尚未进行前瞻性评估。本研究旨在确定GPN阻滞作为局部麻醉药给药的一种途径，在通过血流动力学、恶心反射及主观疼痛反应评估时，是否优于清醒直接喉镜检查。
采用前瞻性、随机、单盲、交叉设计。所有参与者（n = 11）均为麻醉医生。评估了三种局部麻醉药给药途径：2分钟的2%利多卡因粘性溶液含漱（S&G）；S&G联合10%利多卡因喷雾（S&G/喷雾）；以及S&G联合1%利多卡因双侧GPN阻滞（S&G/阻滞；前扁桃体柱法）。局部麻醉药给药5分钟后，进行喉镜检查并持续20秒。测定无创血流动力学指标及血清利多卡因浓度。采用视觉模拟评分量表及研究后问卷评估参与者耐受局部麻醉药给药及喉镜检查的能力，以及他们在临床实践中的选择。
未观察到显著的血流动力学变化，尽管在喉镜检查后第一分钟，S&G/阻滞组心率有适度升高（< 15%）。S&G/阻滞组在5分钟和10分钟时的血清利多卡因浓度（0.5 ± 0.1和1.0 ± 0.2微克/毫升）高于S&G组（P < 0.05）。评估参与者耐受喉镜检查能力的视觉模拟评分量表显示，S&G（5.4 ± 0.9）导致的不适比S&G/喷雾（3.5 ± 0.9）或S&G/阻滞（3.3 ± 0.7）更多（P < 0.05）。评估喉镜检查视野清晰度的喉镜检查者视觉模拟评分量表显示，与S&G（4.0 ± 1.3）和S&G/阻滞（3.7 ± 1.1）相比，S&G/喷雾（1.8 ± 0.9）出现咳嗽和恶心反射的趋势较小（P < 0.08）。91%的参与者报告S&G/阻滞后口咽不适持续24小时或更长时间，而S&G或S&G/喷雾后无参与者报告口咽不适。与S&G（P < 0.01）和S&G/阻滞（P < 0.05）相比，显著更多的参与者（73%）表示他们在未来临床实践中更倾向于使用S&G/喷雾。
舌咽神经阻滞并非清醒直接喉镜检查局部麻醉药给药的更佳途径。2分钟的2%利多卡因S&G随后10%利多卡因喷雾是参与者和喉镜检查者首选的麻醉途径。
