Gag Reflex
Conditions
Brief summary
The investigators will test the effects of ultrasound guided airway nerve block vs lidocaine topical anesthesia and it's direct effect in decreasing incidence of gag and cough reflex in suspected difficult intubation patients using video assisted laryngoscopey for those Undergoing bariatric surgery
Detailed description
A.Preoperative settings: A thorough preoperative evaluation including a complete airway evaluation (mouth opening, mallampati grading, body weight, thyromental distance, and evaluation of dentition) will be performed. Standard fasting guidelines and anti-aspiration prophylaxis with tablet ranitidine 150 mg will be prescribed. The patients will be explained about the awake C-MAC intubation during preoperative assessment.Injection of atropine 0.4 mg will be given half an hour before shifting the patient to the operating room (OR). B.Intraoperative and postoperative settings: Injection of atropine 0.4 mg will be given half an hour before shifting the patient to the operating room (OR). Inside the OR, standard monitoring, including electrocardiography (ECG), noninvasive blood pressure (BP), and pulse oximetry (SpO2) will be applied in all patients. An intravenous (IV) line will be secured and ringer lactate will be started. After recording the baseline heart rate (HR), BP and SpO2, Injection of Dexametomidate 0.7 mcg/kg/hr IV infusion and injection ketamine 0.5-2 mg/kg slow IV single dose until endotracheal tube secured. For each group, local anesthetics will be given in first group (LA)guided by ultrasound and second group (T) with topical method until Adequate effect of local anesthesia confirmed by hoarseness of voice in Group LA patients and numbness of tongue in Group T patients. While giving supplemental oxygen through nasal prongs, C-MAC intubation will be performed. After the airway is secured, general anesthesia will be administered with propofol 2 mg/kg, and rocuronium 0.6 mg/kg. Postoperatively, patient comfort will be assessed for sore throat, dysphagia, voice change, or any lip, gum, tongue, dental injuries, complete amnesia, partial recall, and unpleasant memories during awake C-MAC intubation.
Interventions
PROCEDUREUltrasound guided airway nerve block for Endotracheal intubation
Glossopharyngeal nerve block: 1.5 mL 2% lidocaine, ultrasound probe on lateral neck below mandible, landmark = hyoid bone, tilt cephalad to target pharyngeal wall near tonsil; right side needle inserted out-of-plane from superior probe edge to avoid artery. Bilateral superior laryngeal nerve blocks: out-of-plane at lateral thyroid cartilage, orient probe medially, inject 1 mL 2% lidocaine into thyrohyoid membrane between hyoid and thyroid cartilage using 25-G 25 mm needle. Bilateral recurrent laryngeal nerve blocks: translaryngeal out-of-plane, locate cricothyroid membrane below thyroid cartilage, insert 25-G 25 mm needle 1.5 cm, confirm air backflow, inject 2 mL 2% lidocaine.
PROCEDURElidocaine topical anesthesia for Endotracheal intubation
will receive topical lidocaine 10% spray directly on the tongue and oropharynx without exceeding toxic doses.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
1. Age: 21-65 years old 2. Obese patients (BMI\>35 kg/m2) undergoing bariatric surgery 3. Suspected difficult intubation: e.g:(Mallampati score ≥3 , Thyromental distance \<6 cm, Limited neck mobility, History of difficult intubation) 4. ASA I-II
Exclusion criteria
1. Patients at increased risk for aspiration (e.g., full stomach or gastro-esophageal reflux disease) and pregnancy 2. Patients with expected difficult ventilation 3. Patients who have upper airway pathology or surgery 4. Patients with a mouth opening \< 2 cm 5. ASA III-IV 6. Emergency surgery 7. Allergy to local anesthetics 8. Contraindication to nerve blocks e.g.:(Coagulopathy, Infection at site of injection) 9. Patient refusal 10. Neurological or cognitive impairment making the patient uncooperative 11. History of difficult airway complications e.g.: previous intubation failure or need for surgical airway 12. Cervical spine instability or fractures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Gag reflex and cough reflex | After applying local anesthesia by at least 3 minutes | After taking local anesthesia monitoring of gag and cough reflexes will be monitored during the process of endotracheal intubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean blood pressure (MAP) | After applying local anesthesia by at least 3 minutes | After taking local anesthesia monitoring of Mean blood pressure (MAP) will be monitored during the process of endotracheal intubation |
Countries
Egypt
Outcome results
None listed