Title : Airway anaesthesia for awake orotracheal fibreoptic intubation in patients with unstable cervical spine. A randomized trial comparing two nerve block techniques
Abstract:
Background and Aims: For awake fibreoptic intubation (AFOI), it is essential to ameliorate the cough, swallowing and gag reflexes which can be done by various airway nerve blocks. The superior laryngeal nerve (supplying sensations above vocal cords) and recurrent laryngeal nerve (supplying sensations below the cords) are conventionally blocked in unison. We compared the conditions for AFOI when a single transtracheal block alone was administered as compared to when bilateral superior laryngeal blocks in combination with transtracheal blocks were administered under ultrasound (US) guidance in patients with preexisting unstable cervical spine
Methods: One hundred and forty patients with cervical spine pathology were randomly allocated to receive either a single transtracheal block or a combination of transtracheal and bilateral superior laryngeal nerve blocks under US guidance before being taken up for AFOI. Comfort of AFOI, represented by patients’ cough and gag scores (Malcharek et al,2015), intubation times, haemodynamic parameters, operator and patients’ experiences and complications were noted
Results: Demographic parameters, intubation times, vital parameters were similar. (p > 0.05 each). Levels of coughing and gagging during the procedure and the time required were comparable. (p > 0.05 each).Intra procedural vital parameters or post procedure sequelae were similar (p>0.05)
Conclusion: Single transtracheal block provides comparable intubating conditions under fibreoptic guidance as compared to combination of transtracheal and bilateral superior laryngeal nerve blocks. Therefore, for airway anaesthesia during AFOI, in view of its less invasiveness, a single transtracheal block can be preferred over the combination of transtracheal and bilateral superior laryngeal nerve blocks.
