Awake Tracheal Intubation Research Articles

A DAS members survey of education and training in awake tracheal intubation

A DAS members survey of education and training in awake tracheal intubation

Repeated videolaryngoscopic awake tracheal intubation in a patient with laryngeal tumour

Repeated videolaryngoscopic awake tracheal intubation in a patient with laryngeal tumour

Anaesthetic consent for awake tracheal intubation in the UK

Anaesthetic consent for awake tracheal intubation in the UK

Development of an Alexa- enabled cognitive aid for Awake Tracheal Intubation

Development of an Alexa- enabled cognitive aid for Awake Tracheal Intubation

Patient versus provider perceptions of awake tracheal intubation

Patient versus provider perceptions of awake tracheal intubation

Airway nerve blocks as an adjunct to lignocaine nebulization for awake fiberoptic intubation

ABSTRACT Background Awake tracheal intubation (ATI) is becoming a gold standard in managing the difficult airway. Airway anesthesia is the cornerstone for the preparation of awake fiberoptic intubation (AFOI). Many topical and regional techniques have been developed to attenuate airway reflexes and facilitate AFOI. Glossopharyngeal superior laryngeal and recurrent laryngeal nerves must be blocked to attain adequate reflex abolishment. Aim This randomized controlled prospective study was performed to evaluate the effectiveness of adding airway nerve blocks to lignocaine nebulization for nasal AFOI. Methodology This was a comparative study conducted in 50 patients randomly allocated into two groups of 25 each: Group A and Group B; both received nebulization of 2% lignocaine 10 mL. Group B was then given airway blocks as bilateral superior laryngeal (2% lignocaine 1.5 mL each) and transtracheal (2% lignocaine 2 mL) block. Group A received the same airway nerve block by the same volume with normal saline 0.9%. Two puffs of 10% lignocaine to the nose and postnasal space on each side were given to both groups. Awake nasal fiberoptic intubation was performed. Vital parameters, such as intubation time, intubation condition, patient comfort scale, satisfaction score, and side effects, were recorded. Statistical analysis for both groups was done. Results Statistically, no significant differences were found in demographics and hemodynamics. Regarding intubation time and intubation condition scale, there was a significant improvement in Group B than in Group A. Also, overall patient comfort and satisfaction scores were significantly better in Group B than in Group A. Conclusion Upper airway lignocaine nebulization may provide adequate anesthesia for AFOI, but when supplemented by airway nerve blocks, it improves the quality of anesthesia and patient satisfaction.

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults.

SummaryAwake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high‐quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post‐tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.

Techniques and complications of awake fibre-optic intubation – A Survey of Difficult Airway Society members

BackgroundAwake fibre-optic intubation (AFOI) is a recommended option for managing the anticipated difficult intubation; however, there is no recommended standard technique. We investigated current practice of AFOI among Difficult Airway Society members. MethodsA survey was distributed to members of the Difficult Airway Society (DAS). Questions focussed on technique, complications and caseload within the previous 2 years. ResultsOf 588 respondents, most (313; 53%) had performed less than 5 AFOI in the previous 2 years; 61 (10%) had not performed any AFOI and were excluded from further analysis. Of those who had performed AFOI within the preceding 2 years (527), remifentanil was used most commonly for single-agent sedation (237; 45%). Most anaesthetists (253; 48%) combined co-phenylcaine and lidocaine for airway topicalisation. A spray-as–you-go technique for topical anaesthesia was used most frequently (398; 76%). Of respondents, 109 (21%) encountered complications. Of these, the most frequently reported complications were requiring three or more attempts (41) followed by desaturation <80% (34) and failed AFOI (32). There was no statistically significant difference in complication rate between sedation techniques. ConclusionAFOI remains the gold standard technique for anticipated difficult airway management, but low case numbers is a cause for concern for skill maintenance and difficult airway training. A wide variation in anaesthetic technique for AFOI may be aided by national guidelines for awake tracheal intubation.

¿Podría ser la videolaringoscopia la técnica de elección para intubación con paciente despierto?

La intubación orotraqueal (IOT) con fibrobroncoscopio es a menudo considerada la técnica de elección cuando nos encontramos ante una vía aérea difícil prevista. Sin embargo, los videolaringoscopios se usan con más frecuencia. Se realizaron búsquedas en la literatura actual y se realizó un metaanálisis para comparar el uso de la videolaringoscopia y la fibrobroncoscopia para la intubación traqueal despierta. El principal objetivo fue el tiempo necesario para intubación. Los objetivos secundarios incluyeron: intubación fallida; la tasa de intubación exitosa en el primer intento; satisfacción informada por el paciente con la técnica; y cualquier complicación resultante de la intubación. Ocho estudios donde se examinaron a 429 pacientes se incluyeron en esta revisión. El tiempo de intubación fue más corto cuando se utilizó la videolaringoscopia en lugar de la fibrobroncoscopia (siete ensayos, 408 participantes, diferencia significativa [IC del 95%] 45,7 (66,0 a 25,4) s, p &lt;0,0001, bajo nivel de evidencia). No hubo diferencias significativas entre las dos técnicas en la tasa de fracaso (seis estudios, 355 participantes, riesgo relativo [IC 95%] 1,01 (0,24-4,35), p = 0,99, bajo nivel de evidencia) o la tasa de éxito de primer intento (seis estudios, 391 participantes, riesgo relativo (IC 95%) 1,01 (0,95-1,06), p = 0,8, nivel de evidencia moderado). El nivel de satisfacción del paciente fue similar entre ambos grupos. No se encontraron diferencias en los eventos adversos informados: ronquera / dolor de garganta (tres estudios, 167 participantes, riesgo relativo [IC 95%] 1,07 (0,62-1,85), p = 0,81, bajo nivel de evidencia) y baja saturación de oxígeno (cinco estudios, 337 participantes, riesgo relativo (IC 95%) 0,49 (0,22-1.12), p = 0,09, bajo nivel de evidencia). En resumen, la videolaringoscopia para la intubación traqueal despierta se asocia con un tiempo de intubación más corto. También parece tener una tasa de éxito y un perfil de seguridad comparable a la fibrobroncoscopia. ABSTRACT Could videolaryngoscopy be the chosen technique for awaken patient intubation? Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly. We searched the current literature and performed a meta-analysis to compare the use of videolaryngoscopy and fibreoptic bronchoscopy for awake tracheal intubation. Our primary outcome was the time needed to intubate the patient’s trachea. Secondary outcomes included: failed intubation; the rate of successful intubation at the first attempt; patient-reported satisfaction with the technique; and any complications resulting from intubation. Eight studies examining 429 patients were included in this review. The intubation time was shorter when videolaryngoscopy was used instead of fibreoptic bronchoscopy (seven trials, 408 participants, mean difference(95%CI) - 45.7 (- 66.0 to -25.4) s, p&lt;0.0001, low-quality evidence). There was no significant difference between the two techniques in the failure rate (six studies, 355 participants, risk ratio (95%CI) 1.01 (0.24–4.35), p=0.99, low-quality evidence) or the first-attempt success rate (six studies, 391 participants, risk ratio (95%CI) 1.01 (0.95–1.06), p=0.8, moderate quality evidence). The level of patient satisfaction was similar between both groups. No difference was found in two reported adverse events: hoarseness/sore throat (three studies, 167 participants, risk ratio (95%CI) 1.07 (0.62–1.85), p=0.81, low-quality evidence),and low oxygen saturation (five studies, 337 participants, risk ratio (95%CI) 0.49 (0.22–1.12), p=0.09,low-quality evidence). In summary, videolaryngoscopy for awake tracheal intubation is associated with a shorter intubation time. It also seems to have a success rate and safety profile comparable to fibreoptic bronchoscopy.

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

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

The Case of a Morbidly Obese Patient in Whom Awake Tracheal Intubation Was Performed Three Times in Six Weeks

The Case of a Morbidly Obese Patient in Whom Awake Tracheal Intubation Was Performed Three Times in Six Weeks

An unusual use of the lightwand for awake tracheal intubation in a patient with anticipated difficult airway

An unusual use of the lightwand for awake tracheal intubation in a patient with anticipated difficult airway

Effect of awake tracheal intubation with intubating larynegeal mask airway on stress responses of hypertensive patients

Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway(ILMA)on stress responses of hypertensive patients. Methods Sixty hypertensive patients, aged 45-64 yr, with body mass index of 20.3-27.5 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective abdominal surgery under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: direct laryngoscope group(group D)and ILMA group(group I). At 3 min after topical anesthesia(T1), while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I(T2), immediately after completion of intubation(T3), when the maximum change in hemodynamics after intubation appeared(at about 15 s after tracheal tubes were placed, T4), and at 5 min after completion of intubation(T5), mean arterial pressure(MAP)and heart rate(HR)were recorded, and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded. Results Compared with the parameters at T1, the MAP, HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D(P 0.05). Compared with group D, the MAP, HR and plasma epinephrine concentrations were significantly decreased at T2-4(P 0.05). Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents, thus increasing the safty of awake tracheal intubation in hypertensive patients. Key words: Hypertension; Laryngeal masks; Intubation, intratracheal

A feasibility study of awake videolaryngoscope-assisted intubation in patients with periglottic tumour using the channelled King Vision® videolaryngoscope.

Airway management in patients with periglottic tumour is a high-risk procedure with potentially serious consequences. There is no consensus on how best to secure the airway in this group of patients. We conducted a feasibility study of awake tracheal intubation using a King Vision® videolaryngoscope with a channelled blade in a cohort of 25 patients, with a periglottic tumour requiring diagnostic or radical surgery. We used 10% and 4% lidocaine to topicalise the airway and midazolam and remifentanil for sedation. We recorded the success rate, number of attempts, time to obtain glottic view, time to intubation and complications. Twenty-three of the 25 patients (92%, 95%CI 75-98%) were intubated with the awake videolaryngoscope-assisted technique, with 17/23 (74%, 95%CI 54-87%) intubations achieved at the first attempt. Five patients required two and one patient, three attempts at intubation. Two patients (8%, 95%CI 2-25%) could not tolerate the procedure due to inadequate topical anaesthesia. Median (IQR [range]) times to obtain glottic view and to intubate were 19 (17-22 [10-30]) s and 49 (42-71 [33-107]) s, respectively. Traces of blood in the airway were observed in 4/25 (16%, 95%CI 6-35%) patients. Although airway management in this group of patients was expected to be difficult, successful awake intubation with the King Vision videolaryngoscope was achieved in the majority of patients within less than a minute. This study highlights a number of potential advantages of awake videolaryngoscope-assisted intubation over other awake methods of securing the airway in patients with upper airway obstruction due to periglottic mass.

A comparison of the Enk Fiberoptic Atomizer Set™with boluses of topical anaesthesia for awake fibreoptic intubation

We compared the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia administered via the working channel during awake fibreoptic tracheal intubation in 96 patients undergoing elective surgery. Patients who received topical anaesthesia via the atomiser, compared with boluses via the fibreoptic scope, reported a better median (IQR [range]) level of comfort: 1 (1-3 [1-10]) vs. 4 (2-6 [1-10]), p < 0.0001; experienced a reduced total number of coughs: 6 (3-10 [0-34]) vs. 11 (6-13 [0-25]), p = 0.0055; and fewer distinct coughing episodes: 7% vs. 27% respectively, p = 0.0133. The atomiser technique was quicker: 5 (3-6 [2-12]) min vs. 6 (5-7 [2-15]) min, p = 0.0009; and required less topical lidocaine: 100 mg (100-100 [80-160]) vs. 200 mg (200-200 [200-200]), p < 0.0001. Four weeks after nasal intubation, the incidence of nasal pain was less in the atomiser group compared with the control group (8% vs. 50%, p = 0.0015). We conclude that the atomiser was superior to bolus application for awake fibreoptic tracheal intubation.

Comparison of Dexmedetomidine and Midazolam for sedation in elderly patients with upper cervical spine fracture in awake tracheal intubation

Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation. Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan. 2010 to Jan. 2015 were considered as the objects, who was randomly divided into group A and group B. 34 cases in group A were treated with Dexmedetomidine for sedation, and the other 34 cases in group B were treated with Midazolam for sedation. The Heart rate (HR), mean arterial pressure (MAP) and BIS value on the before anesthesia (T1), immediately before intubation (T2), immediately after intubation (T3), PaCO2 in before and after intubation, and the adverse reactions were compared between the two groups. Results There was no difference in HR, MAP and BIS at time of T1 between the two groups (P>0.05). The HR, MAP and BIS were lower in group A than in group B at time of T2 and T3 (P 0.05). The rate of adverse effects had no difference between the two groups (χ2=1.308, P=0.253). Conclusions Compared with Midazolam, Dexmedetomidine can stable HR, MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation, which is worthy of clinical application. Key words: Dexmedetomidine; Midazolam; Cervical vertebrae; Fractures; Intubation, intratracheal

The use of the Airtraq® in Awake Tracheal Intubation: A Case Series

Objective To report the clinical experience in using the Airtraq® in awake tracheal intubation in patients with known or potential difficult airway, or unstable cervical spine. Methods Case series study. Twenty patients with known or potential difficult airway, or unstable cervical spine who underwent elective operations and might require awake fibreoptic intubation were recruited. After standardised topical anaesthesia of the airway, awake intubation was performed using the Airtraq®. The duration of the intubation procedure, the intubation difficulty scale (IDS), the rate of successful placement of endotracheal tube and patient's satisfaction were recorded. Results Fifteen out of the twenty patients were successfully intubated with the Airtraq® under awake condition leading to an overall success rate of 75%. Eleven of them were intubated in the first attempt. The mean duration of intubation was 1 min 33 s. Concerning the degree of difficulty of intubation using the Airtraq®, as evaluated with the IDS, 20% was ranked as easy and 80% was slightly difficult. Excessive secretion, patient gagging, inability to cooperate and inadequate view of larynx were the major reasons of failed intubation. Eighty percent of the patients considered the intubating procedure with the Airtraq® under awake condition acceptable. In general, patients felt mild pain and discomfort and were satisfied with the intubation process. Conclusion Airtraq® may be a useful alternative of flexible bronchoscope for awake intubation with low rate of minor complications in the elective operation setting. (Hong Kong j.emerg.med. 2015;22:248-255)

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12years: an historical cohort study.

Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002-2013) at our institution. The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12years were analyzed using linear regression modelling. Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4(-4) incidence·year(-1); 95% confidence interval [CI]: -3.0(-4) to 3.0(-5); P=0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidence·year(-1); 95% CI: 0.076 to 0.083; P<0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011-2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway.

Efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope in elderly patients

Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients. Methods Sixty elderly patients aged 65-77 yr, of ASA physical status Ⅱ or Ⅲ(Mallampati grade Ⅰ or Ⅱ), scheduled for elective surgery under general anesthesia, were randomly divided into 3 groups (n=20 each) using a random number table: dezocine group (group DEZ), dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+ DEX). Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+ DEX, dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min, and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2% lidocaine for topical anesthesia during infusion in all the three groups.In addition, 1% tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR>30% of baseline values) and respiratory depression (SpO2<90% and RR<8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia, when epiglottis came into view, immediately after tracheal tube was successfully inserted into trachea, and at 3 min after successful intubation, perfusion index and Ramsay sedation score, and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded. Results Compared with group DEZ or DEX, the tolerance of tracheal tube was significantly enhanced, intubation time was shortened, the rate of satisfactory sedation was increased, perfusion index and the incidence of cardiovascular response were decreased in DEZ+ DEX group.There was no significant difference in respiratory depression among the three groups. Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients. Key words: Dexmedetomidine; Analgesics, opioid; Intubation, intratracheal; Aged; Bronchoscopy

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

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/.