After approval of the protocol by the Institutional Review Board, 50 adult patients with traumatic cervical spine injury undergoing cervical spine fixation surgery were recruited for the study over a period of 12 months. A written informed consent was obtained from each patient. Uncooperative patients, those allergic to LA, asthmatics, epileptics and those with deranged coagulation, hemodynamic instability, bradyarrhythmias, or infection at the local site were excluded from the study.
A thorough preoperative evaluation including a complete airway evaluation (mouth opening, mallampati grading, thyromental distance, and evaluation of dentition) was performed. Standard fasting guidelines and anti-aspiration prophylaxis with tablet ranitidine 150 mg were prescribed. The patients were explained about the awake FOB guided intubation during preoperative assessment. Injection glycopyrrolate 5 μg/kg was given intramuscularly half an hour before shifting the patient to the operating room (OR). Inside the OR, standard monitoring, including electrocardiography (ECG), noninvasive blood pressure (BP), and pulse oximetry (SpO2) were applied in all patients. An intravenous (IV) line was secured and ringer lactate was started. An arterial line was established under local anesthesia. After recording the baseline heart rate (HR), BP and SpO2, injection midazolam 20 μg/kg and injection fentanyl 1 μg/kg were given IV.
The patients were randomly allocated into two groups. Randomization was done using computer generated tables of random numbers. Group L (n = 25) received 10 ml of 4% lignocaine by ultrasonic nebulizer (LD 10185, Honsun, Shanghai, China) for 15 min, and Group NB (n = 25) received bilateral superior laryngeal nerve and transtracheal instillation of 2 ml of 2% lignocaine, along with viscous xylocaine gargles twice. Adequate effect of local anesthesia was confirmed by heaviness of tongue in Group L patients and by hoarseness of voice in Group NB patients.
While giving supplemental oxygen through nasal prongs, FOB guided intubation was performed. Size 8.0 mm internal diameter endotracheal tube was used for male patients and 7.5 mm for female patients. Vital parameters (HR, BP, and SpO2) were also recorded during intubation and at 1 min and 3 min postintubation. Supplemental LA was given as 1 ml aliquots of 2% lignocaine through the working channel of FOB (next aliquot given only after waiting for 30-60 s). Other parameters such as gag/cough reflex, cord visibility (relaxed, partially relaxed or adducted on endoscopic view), and ease of intubation [Table 1 ] were also recorded. Any signs of lignocaine toxicity such as ECG changes, seizures, and bronchoconstriction were also noted. After the airway was secured, general anesthesia was administered with propofol 2 mg/kg, and rocuronium 0.6 mg/kg. Postoperatively, patient comfort was assessed for complete amnesia, partial recall, and unpleasant memories during awake FOB guided intubation.
All data were tabulated and analyzed statistically. Parametric values were reported as mean ± standard deviation. Hemodynamic variables were compared using the unpaired Student's t-test. Intubation grades and patient comfort scores were compared using the Mann — Whitney U test. Statistical significant value was considered if P < 0.05.
A thorough preoperative evaluation including a complete airway evaluation (mouth opening, mallampati grading, thyromental distance, and evaluation of dentition) was performed. Standard fasting guidelines and anti-aspiration prophylaxis with tablet ranitidine 150 mg were prescribed. The patients were explained about the awake FOB guided intubation during preoperative assessment. Injection glycopyrrolate 5 μg/kg was given intramuscularly half an hour before shifting the patient to the operating room (OR). Inside the OR, standard monitoring, including electrocardiography (ECG), noninvasive blood pressure (BP), and pulse oximetry (SpO2) were applied in all patients. An intravenous (IV) line was secured and ringer lactate was started. An arterial line was established under local anesthesia. After recording the baseline heart rate (HR), BP and SpO2, injection midazolam 20 μg/kg and injection fentanyl 1 μg/kg were given IV.
The patients were randomly allocated into two groups. Randomization was done using computer generated tables of random numbers. Group L (n = 25) received 10 ml of 4% lignocaine by ultrasonic nebulizer (LD 10185, Honsun, Shanghai, China) for 15 min, and Group NB (n = 25) received bilateral superior laryngeal nerve and transtracheal instillation of 2 ml of 2% lignocaine, along with viscous xylocaine gargles twice. Adequate effect of local anesthesia was confirmed by heaviness of tongue in Group L patients and by hoarseness of voice in Group NB patients.
While giving supplemental oxygen through nasal prongs, FOB guided intubation was performed. Size 8.0 mm internal diameter endotracheal tube was used for male patients and 7.5 mm for female patients. Vital parameters (HR, BP, and SpO2) were also recorded during intubation and at 1 min and 3 min postintubation. Supplemental LA was given as 1 ml aliquots of 2% lignocaine through the working channel of FOB (next aliquot given only after waiting for 30-60 s). Other parameters such as gag/cough reflex, cord visibility (relaxed, partially relaxed or adducted on endoscopic view), and ease of intubation [
All data were tabulated and analyzed statistically. Parametric values were reported as mean ± standard deviation. Hemodynamic variables were compared using the unpaired Student's t-test. Intubation grades and patient comfort scores were compared using the Mann — Whitney U test. Statistical significant value was considered if P < 0.05.
