At a glance
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A Comparative Study Between Atomization and Nebulization for Airway Topicalization During Awake Nasotracheal Fiberoptic Intubation
In Brief
A clinical study evaluating Nebulization with lidocaine and Atomization with lidocaine for Awake Fiberoptic Intubation. Completed, enrolled 150 participants across 1 site.
Detailed Summary
Intubation of difficult airway is a challenge for anesthetist. There many causes of difficult airway, and previous studies concluded that awake fiber-optic intubation (AFOI) is the gold standard for the management of these patients. Several studies showed that airway nerve blocks provide rapid and deep airway anesthesia, however, due to their several disadvantages, topicalization of the airway represents a promising alternative to them. Some studies revealed that nebulization and atomization of the airway provide adequate anesthesia for AFOI. In the present study, we try to find out which is more effective for topicalization of the airway during nasotracheal AFOI; nebulization or atomization. We used a simple atomization device as a modification of the McKenzie technique.
Study Details
Timeline
Interventions
A face mask nebulizer with oxygen flow rate of 8 L/min will be used to deliver 10 mL of 2% lidocaine. Patients will be encouraged to inhale deeply to facilitate entrainment of nebulized LA into their airway. Adequate topical anesthesia will be confirmed by heaviness or numbness of the tongue.
A simple atomization device as a modification of the McKenzie technique will be used. One end of oxygen bubble tubing will be cut to fit into the barrel of 1 mL syringe and attached to one connector of a 3-way tap. A 10-mL syringe filled with 2% lidocaine will be attached to the other connector of the 3-way tap. A 6 Fr suction catheter, with its colored end cut and its distal blind end cut open, will be attached to oxygen bubble tubing via the male Luer connector of the 3-way tap. The other end of bubble tubing will be then attached to an oxygen source turned on to deliver a flow of 6 L/min. As LA is slowly atomized as a jet-like spray, the catheter will be directed towards the soft palate and posterior pharynx in a controlled fashion during patients' inspiration to topicalize the airway. Patients will be asked to take full vital capacity breaths of atomized LA contained oxygen. Adequate topical anesthesia will be confirmed by tongue heaviness or numbness