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Med J Armed Forces India. 2005 Jan;61(1):22-5. doi: 10.1016/S0377-1237(05)80112-1. Epub 2011 Jul 21.

Local Anaesthesia for Fiberoptic Intubation : A Comparison of Three Techniques.

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Classified Specialist (Anaesthesia and Paediatric Anaesthesia), Army Hospital (R & R), Delhi Cantt.
Ex-Professor & Head, Department of Anaesthesiology & Critical care, Armed Forces Medical College, Pune-40.
Commandant, Armed Forces Medical Store Depot, Lucknow.
Graded Specialist (Anaesthesia), 7 Air Force Hospital, Kanpur.



The successful conduct of fiberoptic aided intubation is dependent upon effective local anaesthesia. The aim of the study was to compare three different methods of anaesthetizing the airway.


60 adult patients (American Society of Anaesthesiologists status I-III and Mallampati class III & IV), scheduled for elective surgery, received sedation followed by spraying of the nares and posterior pharyngeal wall with 4% lignocaine. Thereafter the patients received 4 ml of 4% lignocaine either by transtracheal injection (n=20, group A), via intubating fiberscope (Pentax F1-10P2) using 'spray as you go' technique (n=20, group B) or by nebulizer (Devilbiss 5610W) 20 min before intubation, (n=20, group C). Patients were asked to score the procedure using visual analog scale (VAS) and severity scores. Episodes of coughing, choking, stridor, extra / total local anaesthetic used and intubation times were recorded. Patients were monitored continuously for vital parameters.


Group B patients showed better VAS scores with shorter intubation times and had a lower incidence of coughing and choking. The endoscopists' VAS scores also showed a preference for group B.


In conclusion the 'spray as you go' technique was safe, provided effective local anaesthesia and was preferred by both patients and endoscopists.


Awake intubation; Difficult airway; Fiberoptic intubation

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