Airway atomization with transtracheal block versus conventional airway nerve blocks for awake fiberoptic intubation: A comparative study

Background: Awake fiberoptic intubation (AFI) is warranted to secure airway safely in patients with anticipated difficult intubation. Nebulization, atomization, or airway nerve blocks (ANBs) are often used for airway anesthesia. Although ANBs are superior to nebulization or atomization, the former may be difficult owing to distorted anatomy and requiring multiple needle pricks. Transtracheal block can supplement atomization to improve airway anesthesia. Aims and Objectives: The study compared the efficacy between “atomization with transtracheal block” and ANBs for AFI. Primary objective was to compare the intubating condition achieved using either of the methods. Secondary objectives were to compare intubation time, cough or gag score, vocal cord position, comfort score, and hemodynamics. Materials and Methods: This open-label, randomized controlled study recruited 140 patients aged 18–65 years, American Society of Anesthesiologist-physical status I-II, requiring reconstructive surgery. Allocation concealment was done to minimize selection bias. Patients were allocated into two groups to receive either ANBs (Group A, n=70) or “atomization plus transtracheal block” (Group B, n=70). Results: Considerably higher proportion of patients achieved optimal and sub-optimal “intubating condition” (67 [95.7%] vs. 62 [88.5%] patients, respectively, P=0.001) and absence of cough and gag (57 [81.4%] vs. 40 [57.1%, respectively, P=0.014]) using “atomization with transtracheal block” compared with ANBs. Both the methods showed a comparable intubation time, vocal cord position, and patient comfort while maintaining a favorable hemodynamics. Conclusion: Atomization supplemented with transtracheal block can be a suitable alternative to conventional ANBs in terms of favorable grades of intubating condition, better suppression of cough and gag reflex.