Blood Pressure After Nerve Block, Hemodynamic Stability During Awake Intubation
Conditions
Keywords
Awake intubation, Nerve block, Nebulized lignocaine, Fibreoptic, Hemodynamic
Brief summary
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.
Interventions
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.
PROCEDURENerve Block
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.
Sponsors
Mayo Hospital Lahore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
2
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Arterial Pressure (MAP) Change During Awake Fiberoptic Intubation | Baseline to 5 minutes after intubation. | Change in mean arterial pressure from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation. |
| Heart Rate Change During Awake Fiberoptic Intubation | Baseline to 5 minutes after intubation. | Change in heart rate from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intubation Time | During the intubation procedure. | Time from insertion of the fiberoptic bronchoscope until confirmation of successful endotracheal tube placement. |
| Patient Comfort Score | Immediately after completion of awake fiberoptic intubation. | Patient comfort assessed using a standardized 5-point tolerance scale. |
| Cough Severity Score | During the intubation procedure. | Severity of coughing during awake fiberoptic intubation assessed using a predefined cough scoring system. |
| Successful Intubation Rate | From intervention administration until 5 minutes after intubation. | Successful placement of an endotracheal tube without the need for rescue airway anesthesia. |
| Procedure-Related Complications | From intervention administration until 5 minutes after intubation. | Incidence of adverse events including airway trauma, desaturation, allergic reactions, hoarseness, or other procedure-related complications. |
Countries
Pakistan
Contacts
CONTACTAniqa Intizar
CONTACTIjaz Khalid
PRINCIPAL_INVESTIGATORAniqa Intizar
Mayo Hospital Lahore
Outcome results
None listed