Comparison of Lightwand and Fiberoptic Techniques for Airway Topical Anesthesia in Patients with Difficult Airways

Abstract

Background: Awake intubation is often regarded as a cornerstone in the management of the known difficult airway, but needs adequate airway topical anesthesia. This randomized clinical study was designed to determine the feasibility, safety and efficacy of the lightwand technique to provide airway topical anesthesia for awake tracheal intubation (ATI) by comparing with the fiberoptic technique.Methods: Eighty adult patients with difficult airways were randomly assigned to one of two study groups to receive airway topical anesthesia by lidocaine sprays with the lightwand (LW group) or fiberoptic bronchoscope (FOB group). After airway topicalization, ATI was also performed using the lightwand and fiberoptic techniques, respectively. Level of sedation, time for each lidocaine spray in different targeted areas, total times for airway sprays, and total dosages of lidocaine were noted. Operators assessed difficulty of the airway spray and ATI using the visual analogue scales (VAS). An independent investigator assessed patients' discomfort during airway topicalization, patients' reaction, coughing severity, and intubating condition during ATI, and observed changes of blood pressure (BP) and heart rate (HR) during airway manipulations. Serial blood samples were obtained for analysis of plasma lidocaine concentrations. Also the postoperative follow-up of complications was done.Results: 96.7% of airway lidocaine sprays were successfully completed on the first attempt in the LW group compared with 84.7% in the FOB group. The operator VAS assessment of difficulty of the airway spray was significantly better, times for each supraglottic spray and first laryngeal spray, and total time for airway sprays were significantly shorter, and total dosages of lidocaine were smaller in the LW group compared with the FOB group. As compared with the FOB group, patients' reaction and coughing scores during ATI were significantly lower, intubating conditions and operator VAS assessment of difficulty of intubation were better, and systolic BP and HR at intubation were significantly lower in the LW group. However, there were not significant differences in the investigator scores of patients' discomfort during airway sprays, plasma lidocaine concentrations at all observed times and the postoperative interview variables between groups.Conclusions: As compared with the fiberoptic technique, use of the lightwand technique to provide airway topical anesthesia is easier for the experienced anesthetists, requires shorter time of airway preparation and smaller dosages of lidocaine, can produce better intubating condition for ATI, and does not result in more postoperative complications in sedated patients with difficult airways. Citation: Fu-Shan Xue, Nong He, He-Ping Liu, Xu Liao, Xiu- Zheng Xu, Jian-Hua Liu, et al. Comparison of lightwand and fiberoptic techniques for airway topical anesthesia in patients with difficult airways. J Anesth Perioper Med 2014; 1: 25-35. doi: 10.24015/JAPM.2014.0005This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.