![]() This can be done in multiple ways, which can broadly be divided into two groups: (a) Topical administration of local anesthetic (LA) and (b) Blockade of neural supply to the oropharynx and larynx. It is essential to sufficiently anesthetize the upper airway and suppress the gag, swallow, and cough reflexes before awake fiberoptic bronchoscope (FOB)-guided intubation and thus ensure patient comfort. AFOI is the gold standard within the management of patients with an anticipated difficult airway. Soft tissue damage is often caused by traumatic attempts at intubation. ![]() Tracheal intubation is sometimes difficult and may end in many complications, the most serious being hypoxemic brain damage and death. Tracheal intubation is the key skill in the care of unconscious, anesthetized, or severely ill patients. Upper airway nerve blocks provide faster intubation, adequate airway anesthesia, and less patient discomfort to aid in AFOI in patients with anticipated difficult airway as compared to topical anesthesia using an atomizer. Between the two groups, group A showed better hemodynamics and fewer episodes of desaturation than group B. Group B had an increased number of coughing/gagging episodes as compared with Group A. The ease of intubation, intubating condition, and patient comfort were better in patients who received airway blocks. The intubation time was found to be significantly lower in Group A (63.80☗.86 seconds) as compared to Group B (184.96☑3.38 seconds) (p=0.0001). The primary outcome measured was intubation time and the secondary outcome included quality of intubation, hemodynamic variables, and any adverse events. Fiberoptic guided orotracheal intubation was then performed in both the groups using LMA MADgic as the conduit. Group A received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal nerve) each with 2 ml of 2% lidocaine and group B received airway anesthesia through atomized lidocaine by LMA MADgic using 10 ml of 2% lidocaine. Our aim was to compare the two modalities, airway nerve blocks and atomized lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic)airway for awake fiberoptic intubation (AFOI).Ī total of 50 patients with anticipated difficult airway requiring AFOI were randomly allocated into two groups. There are situations where the safest method to secure an airway is to place an endotracheal tube in an awake and spontaneously breathing patient. Awake intubation is used most commonly in patients with a predicted difficult airway.
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