Efficacy of an airway topical anesthesia catheter for topical anesthesia using a spray-as-you-go technique via fiberoptic bronchoscope

Abstract

Objective To evaluate the efficacy of an airway topical anesthesia catheter for topical anesthesia using a spray-as-you-go technique via the fiberoptic bronchoscope (FOB). Methods Forty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients with obstructive sleep apnea syndrome, aged 20-64 yr, with body mass index of 23-35 kg/m2, with no upper respiratory tract infection within 1 week before operation, scheduled for elective uvulopalatopharyngoplasty, were divided into 2 groups (n=20 each) using a random number table: routine control group (group C) and FOB-airway topical anesthesia catheter group (group F). In group C, the pharynx and larynx were sprayed with lidocaine FOB by using a laryngo-tracheal mucosal atomization device, and cricothyroid membrane puncture was performed and then lidocaine was injected.In group F, airway topical anesthesia was performed using a spray-as-you-go technique via the FOB with an airway topical anesthesia catheter spraying lidocaine via the nose.At 5 min after topical anesthesia of the airway, FOB-guided intubation was performed, and dexmedetomidine was intravenously infused at 0.1 μg·kg-1·min-1 for sedation in both groups.Ramsay sedation scores were assessed after topical anesthesia and before intubation.The scores for the intubating condition and tolerance of tracheal tube were assessed during FOB-guided intubation.Successful intubation and the development of responses to intubation and hypoxemia were recorded.The patients were followed up one day after the end of operation, and parents′ satisfaction with the procedure of intubation was recorded. Results Compared with group C, the intubating condition score, tolerance of tracheal tube score, success rate of intubation at first attempt and rate of parents′ satisfaction with the procedure of intubation were significantly increased, and the incidence of responses to intubation was decreased (P 0.05). Conclusion When the FOB is used to guide awake nasotracheal intubation, the airway topical anesthesia catheter provides better efficacy, better intubating conditions, and fewer side effects when applied for topical anesthesia using a spray-as-you-go technique via the FOB, it can be easily accepted by the patients and the efficacy is better that of routine airway topical anesthesia. Key words: Administration, spray; Anesthesia, intratracheal; Bronchoscopy; Intubation, intratracheal