Aims of Study: This study was planned to evaluate the efficacy, hemodynamic changes, patient comfort and safety during awake fiberoptic intubation done under combined regional blocks vs conscious sedation.
Materials and Methods: Eighty patients were included:36 (45%) were subjected to local anesthesia (LA) and 44 (55%) to conscious sedation. Patients of (ASA) Grade I–II, Mallampati Grade I–IV who were undergoing elective intubation were selected. In LA group nerve blocks given were- bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine. Patients responded to a visual analogue scale (VAS) for cough, choking, dyspnea, nausea, vomiting, nasal symptoms, chest pain, and anxiety during bronchoscopy. Postbronchoscopy VAS included cough, fever, dyspnea, nausea, vomiting, nasal symptoms, and hemoptysis. Lastly, VAS for the tolerability of bronchoscopy and acceptance to repeat the procedure were answered. Operator VAS included cough, desaturations, easiness of the procedure, and success. Recovery times and cost were recorded.
Results: Procedure with LA was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Patient comfort was satisfactory with 90% of patients having favorable grades in LA group. All other variables were almost comparable in both the groups.
Discussion: The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient’s anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which, in our study we used the nerve block technique.
Conclusion: A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.
