Efficacy of injecting drugs through fiberoptic bronchoscope and epidural catheter in improving topical anesthesia for awake tracheal intubation in patients undergoing cervical surgery

Abstract

Objective To evaluate the efficacy of injecting drugs through fiberoptic bronchoscope(FOB)and epidural catheter in improving topical anesthesia for awake tracheal intubation in patients undergoing cervical surgery. Methods Fifty patients with cervical spine injury that requiring surgical treatment, aged 18-64 yr, of American Society of Anesthesiologists physical statusⅠor Ⅱ, were divided into 2 groups(n=25 each)using a random number table method: FOB injection hole group(groupⅠ)and FOB combined with epidural catheter group(group Ⅱ). In groupⅠ, 2% lidocaine was sprayed through the FOB injection hole on the oropharynx posterior(2 ml), glottis above vocal cords(3 ml)and the site 5 cm below the glottis(2 ml). In group Ⅱ, 2% lidocaine was sprayed via the epidural catheter implanted through FOB injection hole on the oropharynx posterior(1 ml), the site above vocal cords(3 ml), the site immediately after crossing the glottis(1 ml), the site 5 cm below the glottis(1 ml), and 2% lidocaine 1 ml was slowly injected into the site 5 cm below the glottis to protuberance via the epidural catheter.Awake nasotracheal intubation was then performed under FOB guidance at 5 min after administration in both groups.When patients presented with severe bucking during operation and did not tolerate severe bucking, the previous procedure was repeated for rescue.When severe bucking was not significantly improved after carrying out rescue measures, thyrocricocentesis was performed and the patients were tracheally intubated.The development of hypertension, tachycardia and hyoxemia was recorded during anesthesia and intubation.The operation time, intubation time, success of intubation at first attempt, requirement for rescue measures and thyrocricocentesis were recorded.The development of bucking, body movement and laryngeal spasm were record during anesthesia and tracheal intubation.JOA score was used to evaluate the occurrence of accentuated spinal cord injury after intubation.Parents′ satisfaction with intubation was recorded and scored on 2nd day after operation. Results Compared with group Ⅰ, the incidence of hypertension and tachycardia was significantly decreased, the operation time was prolonged, the requirement for rescue measures and incidence of thyrocricocentesis were decreased, the incidence of body movement and bucking was decreased, and the parents′ satisfaction scores were increased(P 0.05). Accentuated spinal cord injury or laryngeal spasm was not found in either group. Conclusion Injecting drugs through FOB and epidural catheter can achieve better efficacy of topical anesthesia for awake tracheal intubation with reduced adverse reactions than injecting drugs through FOB injection hole in patients undergoing cervical surgery. Key words: Intubation, intratracheal; Anesthesia, intratracheal; Bronchoscopy