“AIRWAY NERVE BLOCKS VS AIRWAY TOPICALIZATION FOR AWAKE FIBEROPTIC BRONCHOSCOPE ASSISTED NASOTRACHEAL INTUBATIONS INTUBATIONS

Abstract

Introduction: To avoid potentially fatal situations such as “can't intubate, can't ventilate,” it is essential to confirm a stable airway before administering general anaesthesia, particularly to patients who have trouble with their airways. Awake fiberoptic bronchoscope assisted nasotracheal intubation (FOI) is recommended for such cases but requires thorough patient preparation to ensure cooperation and comfort. Adequate sedation and opioid use are essential to maintain comfort while keeping the airway patent. Mild sedation combined with local anaesthetics offers excellent hemodynamic stability, although anxiety can complicate the process by triggering autonomic responses. Effective anaesthesia during intubation relies on comprehensive knowledge of airway anatomy and innervation, using various topical and regional techniques to desensitize specific regions. Topical anaesthesia methods include sprays and nebulizers, while nerve blocks, though more challenging, provide superior anaesthesia when performed by experienced anaesthesiologists. Materials and Methods: A single blinded randomized controlled trial was performed from September 2022 to February 2024 with 50 adult patients (>18 years) undertaking elective surgeries under general anaesthesia requiring xv fibreoptic bronchoscope assisted nasotracheal intubations at R. L. Jalappa Hospital and Research Centre, Tamaka, Kolar. Randomization done on 50 patients with 1:1 allocation using block randomization with unequal block size into nerve block (N) group and topicalization (T) group. The study was started after Institutional Ethical Clearance (IEC). Standard pre--, intra--, and post--operative care was taken for both the groups. A t--test for independent samples was employed to compare the continuous variables of the two groups. For all statistical tests, a p--value less than 0.05 was deemed to indicate statistical significance.