Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons

Abstract

Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provides anaesthesia of the airway from the infraglottic area to the epiglottis. Additional topical application of local anesthetic to the oral, along with appropriate sedation, by fentayl and propofol provides satisfactory analgesia for endoscopic procedures The glossopharyngeal nerve (i.e., cranial nerve IX) supplies sensation to the posterior third of the tongue, the pharynx, and the superior surface of the epiglottism. Methods: The level of sedation was recorded using Ramsay sedation score. The time of the block, duration of the procedure were also recorded. Arterial blood gases (ABG) was withdrawn after the beginning of the procedure and by the end of the procedure and recorded, event of desaturation as well, The operator and the patients’ satisfaction were also assessed. After the end of the procedure the patients were admitted to recovery room till gag and cough reflexes regained and by the time the patients were reporting that they became no more feeling numbness, clear fluid were started. Results: The mean Duration of procedure, Time of block and Amount of sedation was 44.7±24.06 min, 15.2±3.05 min, and 18.9±10.2 ml respectively. tracheal biopsy was the most common procedure done (40%). In all the patients the Ventilation were Spontaneous and Stable all through the procedure. Arterial blood gases were normal in all the cases. no statistical significance between the depth of the sedation and patients satisfaction but there was statistical significance between the level of the sedation and the operator satisfaction. The mean recovery time from the end of the procedures till the patients fully awake, and hospital stay was 3.5±2.6 min, and 2.2±0.42 hr respectively. No Postoperative complications were recorded. 90% of the Patients were satisfied, while operator satisfaction was 60%. Conclusion: Airway block with sedation is a safe and reliable practice for high risks patients scheduled for interventional bronchoscopic procedures on a day case basis.