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Awake Fiberoptic Intubation with Two Different Techniques of Local Anaesthetic Administration (Transtracheal Injection Versus Ultrasonic Nebulization) in Patients Undergoing Maxillofacial Surgery

Anil Kumar Bhiwa , Karuna Sharma1 , Anil Kumar Bhiwal2 , Chintan Mukesh Kumar Patel3

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Indian Journal of Anesthesia and Analgesia 6(2):p 577-584, MARCH-APRIL 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6219.32

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Karuna Sharma, Anil Kumar Bhiwal, Chintan Mukesh Kumar Patel. Awake Fiberoptic Intubation with Two Different Techniques of Local Anaesthetic Administration (Transtracheal Injection Versus Ultrasonic Nebulization) in Patients Undergoing Maxillofacial Surgery. Indian J Anesth Analg. 2019;6(2):577-584.

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Abstract

Background and Aims: Awake fiberoptic intubation (AFOI) is considered the gold standard for anticipated difficult intubation in maxillofacial surgery. Regional anaesthesia of the airway is essential for awake fiberoptic intubation. The aim of this study was to compare the efficacy of two different techniques of local anaesthetic administration namely; nebulization and transtracheal injection for AFOI. Materials and Method: This prospective randomised double blind study was conducted on 60 patients of age more than 18 years, ASA grade I-III undergoing maxillofacial surgery who had anticipated difficult intubation. Patients were divided into two group; Group T received transtracheal injection with 4 ml of 4% lignocaine and Group N received ultrasonic nebulization with 4 ml of 4% lignocaine before performing AFOI. All patients received procedural sedation with fentanyl and dexmedetomidine. Time taken to intubate the patient, ease of intubation assessed by cough severity score, patient comfort score, the quality assessment of the entire procedure with post-intubation patient satisfaction and hemodynamic changes were recorded and compared. The data were presented as mean ± SD, median and range. Statistical analysis was done by student t-test for quantitative variables and chi-square test for categorical variables. p value < 0.05 was considered statistically significant. Result: Time taken to intubate the patient was significantly less in Group T 131.27 ± 71.81 sec vs 220.97 ± 102.45 sec in Group N; (p=0.0002). Cough severity, patient comfort and quality of procedure with post-intubation patient satisfaction score were also significantly better in Group T (p=0.0023, 0.0018, 0.0001) while haemodynamic variables were comparable in both the groups. Conclusion: Transtracheal technique provided better quality of anaesthesia with shorter intubation time as compared to the nebulization technique for AFOI in patients undergoing maxillofacial surgery.

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Karuna Sharma, Anil Kumar Bhiwal, Chintan Mukesh Kumar Patel. Awake Fiberoptic Intubation with Two Different Techniques of Local Anaesthetic Administration (Transtracheal Injection Versus Ultrasonic Nebulization) in Patients Undergoing Maxillofacial Surgery. Indian J Anesth Analg. 2019;6(2):577-584.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6219.32

Keywords

Awake fiberoptic intubation (AFOI); Nebulization; Transtracheal injection; Local anaesthetic.

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