Comparative effect of airway blocks, local anaesthetic nebulization and Spray as you go technique for awake flexible bronchoscope assisted nasotracheal intubation: A Randomized Interventional Study at SMS Medical College, Jaipur

Flexible bronchoscopy assisted nasotracheal intubation is the standard technique in patients undergoing head and neck cancer surgeries. Awake flexible bronchoscopy is usually recommended in difficult airway situations because an awake patient can sustain ventilation and oxygenation without assistance, pharyngeal muscle tone and phonation are preserved, can swallow its secretions thus keeping the pharynx clear and other alternatives to deal with the difficult airway can still be used. Thus it is essential to anesthetize the upper airway adequately and suppress the gag, swallow, and cough reflexes prior to awake flexible bronchoscope (FOB) guided intubation to ensure patient comfort. The various techniques for local anaesthesia of the airway include nebulisation using a nebuliser, spraying local anaesthetic directly over the mucosa through the working channel of the flexible bronchoscope which is also called ‘spray as you go’ technique or by giving nerve blocks.