COMPARISON OF AIRWAY NERVE BLOCK VERSUS NEBULIZED LIDOCAINE ON HEMODYNAMIC RESPONSES DURING AWAKE FIBEROPTIC INTUBATION

N/ANot Yet RecruitingNCT07627100

Mayo Hospital Lahore80 enrolled

Overview

This prospective randomized controlled trial aims to compare the effectiveness of airway nerve blocks versus nebulized lidocaine in attenuating hemodynamic responses during awake fiberoptic intubation in adult patients with anticipated difficult airways. Eighty patients undergoing elective surgery requiring awake fiberoptic intubation will be randomly assigned to receive either airway nerve blocks (glossopharyngeal and transtracheal blocks with lidocaine) or nebulized lidocaine. The primary outcome will be changes in heart rate and mean arterial pressure during and after intubation. Secondary outcomes include intubation conditions, patient comfort, cough severity, intubation time, and procedure-related complications. The study aims to identify the most effective airway anesthesia technique for maintaining hemodynamic stability and improving patient tolerance during awake fiberoptic intubation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Blood Pressure After Nerve Block Hemodynamic Stability During Awake Intubation

Nebulized LidocaineDRUG

Participants will receive 4% lidocaine administered via nebulization for 15 minutes before awake fiberoptic intubation to provide topical airway anesthesia and suppress airway reflexes during the procedure.

Nerve BlockPROCEDURE

Participants will receive airway anesthesia using bilateral glossopharyngeal nerve block and transtracheal block with 2% lidocaine before awake fiberoptic intubation to provide airway anesthesia and suppress airway reflexes during the procedure.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: Adults aged 18 to 65 years. American Society of Anesthesiologists (ASA) physical status I-III. Scheduled for elective surgery requiring awake fiberoptic intubation. Anticipated difficult airway. Able and willing to provide written informed consent Exclusion Criteria: Known allergy or hypersensitivity to lidocaine or other local anesthetics. Coagulopathy or bleeding disorders. Severe respiratory disease. Hemodynamic instability. Pregnancy. Refusal to participate in the study. Inability to cooperate with awake fiberoptic intubation or study procedures

Outcomes

Primary Outcomes

Mean Arterial Pressure (MAP) Change During Awake Fiberoptic Intubation

Change in mean arterial pressure from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation.

Time frame: Baseline to 5 minutes after intubation.

Heart Rate Change During Awake Fiberoptic Intubation

Change in heart rate from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation.

Time frame: Baseline to 5 minutes after intubation.

Secondary Outcomes

Intubation Time

Time from insertion of the fiberoptic bronchoscope until confirmation of successful endotracheal tube placement.

Time frame: During the intubation procedure.

Patient Comfort Score

Patient comfort assessed using a standardized 5-point tolerance scale.

Time frame: Immediately after completion of awake fiberoptic intubation.

Cough Severity Score

Severity of coughing during awake fiberoptic intubation assessed using a predefined cough scoring system.

Time frame: During the intubation procedure.

Successful Intubation Rate

Successful placement of an endotracheal tube without the need for rescue airway anesthesia.

Time frame: From intervention administration until 5 minutes after intubation.

Procedure-Related Complications

Incidence of adverse events including airway trauma, desaturation, allergic reactions, hoarseness, or other procedure-related complications.