Efficacy of airway topical anesthesia with combination of superior laryngeal nerve block and thyrocricoid membrane puncture for tracheal intubation in pediatric patients with Pierre Robin Sequence

Abstract

Objective To evaluate the efficacy of airway topical anesthesia with combination of superior laryngeal nerve block (SLNB) and thyrocricoid membrane puncture for tracheal intubation in the pediatric patients with Pierre Robin Sequence. Methods Thirty-two American Society of Anesthesiologist physical status Ⅰ or Ⅱ pediatric patients with Pierre Robin Sequence, aged 5-12 months, weighing 5-13 kg, scheduled for elective cleft palate repair under general anesthesia, were divided into 2 groups (n=16 each) using a random number table method: control group (group C) and airway topical anesthesia with SLNB-thyrocricoid membrane puncture group (group ST). After anesthesia was induced by inhaling sevoflurane by mask on admission to the operating room, 2% lidocaine 0.5 ml was injected around the bilateral superior laryngeal nerve under ultrasound guidance, and then 2% lidocaine 1 ml was injected via the thyrocricoid membrane in group ST, and the root of tongue, pharynx and larynx were sprayed with 2% lidocaine by using a laryngotracheal mucosal atomization device in group C. The pediatric patients were tracheally intubated guided by a video laryngoscope 3 min later.The development of cardiovascular responses, vocal cord activity and body movement was recorded during intubation.The intubation time, success rate of intubation at first attempt and patient′s tolerance to tube were recorded.The occurrence of postoperative hoarseness was also recorded. Results Compared with group C, the incidence of cardiovascular responses, vocal cord activity and body movement was significantly decreased, the intubation time was shortened, the success rate of intubation at first attempt was increased, and the patient′s tolerance to tube score was decreased in group ST (P<0.05). Conclusion Airway topical anesthesia with combination of SLNB and thyrocricoid membrane puncture can provide better intubation conditions when used for the pediatric patients with Pierre Robin Sequence. Key words: Nerve block; Anesthesia, local; Intubation, intratracheal; Pierre Robin Syndrome