Abstract
Airway topicalization is frequently utilized by anesthesiologists to facilitate open airway procedures, aid intubation for a difficult airway, and prevent adverse respiratory events. This review article summarizes the techniques available for airway topicalization for a patient who is deemed to be difficult to intubate. We focus on the indications for use, local anesthetic maximum dosages and safety profiles, sedation techniques, and trials and pitfalls during airway topicalization for difficult intubation.
Highlights
BackgroundIn the general population, the approximate incidence of Cormack and Lehane laryngoscopy grades 3 and 4 is 10%, difficult intubation is 1%, and difficult bag-mask ventilation is 0.08%-5% [1,2]
The flexible bronchoscope was advanced into the trachea 2 cm below the vocals cords, where more local anesthetic (LA) was sprayed. Researchers found that both LA concentrations have similar efficacy for topical airway anesthesia utilizing the SAYGO technique, but the total dosage of LA and plasma concentration was lower in the 2% lidocaine group
The mucosal atomization device (MAD)® Mucosal Atomization Device (Wolfe Tory Medical Inc., South Salt Lake City, UT) is a flexible stylet attached to a syringe via a fine mist, less likely to irritate the airway than a jet
Summary
The approximate incidence of Cormack and Lehane laryngoscopy grades 3 and 4 is 10%, difficult intubation is 1%, and difficult bag-mask ventilation is 0.08%-5% [1,2]. 4% lidocaine can be added to a nebulizer and delivered with oxygen for 30 minutes as an effective and noninvasive way for airway topicalization down to the trachea in patients with limited mouth opening (Figure 5). The flexible bronchoscope was advanced into the trachea 2 cm below the vocals cords, where more LA was sprayed Researchers found that both LA concentrations have similar efficacy for topical airway anesthesia utilizing the SAYGO technique, but the total dosage of LA and plasma concentration was lower in the 2% lidocaine group. The MAD® Mucosal Atomization Device (Wolfe Tory Medical Inc., South Salt Lake City, UT) is a flexible stylet attached to a syringe via a fine mist, less likely to irritate the airway than a jet This technique is useful to anesthetize important laryngeal structures and can only be done under direct laryngoscopy.
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