Effect of nebulization with lignocaine, dexmedetomidine and lignocaine with dexmedetomidine on degree of ease of fiber-optic intubation.

After obtaining approval from Ethic Committee of our Institute, this observational study will be performed on 60 ASA I-II adult patients of either gender, aged 18-60, scheduled for elective surgeries under general anaesthesia will be chosen after obtaining their consent to participate in this study.  Standard anaesthesia monitoring will be established (ECG, NIBP, CAPNOGRAPHY, HR, SPO2), IV access with 18G IV canula will be secured. The patients will be divided into three groups as per the discretion of the anaesthesiologist and patient’s clinical condition as Group D, Group L, Group DL to receive nebulization with 4% lignocaine 5ml, dexmedetomidine 2mcg/kg, 4% lignocaine 5ml + dexmedetomidine 2mcg/kg respectively. Glycopyrrolate 0.2mg IM will be given 30 minutes before surgery and two drops of 0.1% Xylometazoline will be instilled in both the nostrils. Patients will be nebulized for 20 minutes before intubation along with oxygenation with nasal prongs at a flowrate of 4L/min. Adequate local anaesthesia will be confirmed by heaviness of the tongue and dryness of posterior pharynx of patients. During fibreoptic intubation, 2ml lignocaine 4% will be administered by spray-as-you-go technique. Fibreoptic intubation will be performed by using flexible fibreoptic bronchoscope preloaded with 7.5mm/7.0mm ET tubes for males and females respectively. ET tube position will be confirmed by auscultation and capnography. Grading system will be used for assessing intubating conditions, vocal cord positions, cough severity, comfort during intubation and post intubation assessment. Intubation time is defined as the time from passing the fibreoptic endoscope tip through the nostril to the first reading obtained by capnography after endotracheal intubation. Continuous monitoring of vitals will be done at baseline, after nebulization and post intubation at 1, 3, 5, 15 minutes. Sedation level will be assessed after nebulisation just before procedure with Ramsay Sedation score. Patients will be induced with standard GA protocol.