A Comparative Study of Airway Nerve Blocks and Atomized Lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic) Airway for Oral Awake Fiberoptic Intubation

Abstract

Background Awake intubation is used most commonly in patients with a predicted difficult airway. There are situations where the safest method to secure an airway is to place an endotracheal tube in an awake and spontaneously breathing patient. 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). Methods A total of 50 patients with anticipated difficult airway requiring AFOI were randomly allocated into two groups. 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. Fiberoptic guided orotracheal intubation was then performed in both the groups using LMA MADgic as the conduit. The primary outcome measured was intubation time and the secondary outcome included quality of intubation, hemodynamic variables, and any adverse events. Results The intubation time was found to be significantly lower in Group A (63.80±7.86 seconds) as compared to Group B (184.96±13.38 seconds) (p=0.0001). The ease of intubation, intubating condition, and patient comfort were better in patients who received airway blocks. Group B had an increased number of coughing/gagging episodes as compared with Group A. Between the two groups, group A showed better hemodynamics and fewer episodes of desaturation than group B. Conclusion 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.

Keywords: airway; conscious sedation; fiber optic technology; local anaesthesia; nerve block..

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Yadav et al.

Figures

Figure 1. The LMA MADgic airway with syringe and oxygen tubing

Laryngo-Tracheal Mucosal Atomization Device: LMA MADgic

Figure 2. Consort flow diagram

Figure 3. Comparison of changes in HR between the groups across the time period

HR: heart rate

Figure 4. Comparison of changes in SBP between the groups across the time periods

SBP: systolic blood pressure

Figure 5. Comparison of changes in DBP between the groups across the time period

DBP: diastolic blood pressure

Figure 6. Comparison of changes in SpO2 between the groups across the time period

SpO2: oxygen saturation