Preparation of the Patient and Combined Topical Anaesthesia and Regional Nerve Blocks in Awake Nasal Intubation for Dental Surgeries.

Corresponding Author:
Dr. Vatsal C. Patel,
A 101, Arjun Grace-Apartment,
Opp. Swaminarayan Temple,
Near Naranpura Tele Exchange,
Shashtrinagar, Ahmedabad-380063,
Gujarat, India.
E-mail: pvatsal14@gmail.com

ABSTRACT

BACKGROUND

The largest class of causes leading to mortality and serious morbidity in anaesthesia are from airway complications. Failure to intubate and ventilate are responsible for about one third of all anaesthetic deaths. Newer techniques like awake blind nasal intubation, fiberoptic intubation and video laryngoscopy have been introduced to tackle conditions like trismus, oral injuries, oral tumours, inadequate mouth opening, predicted difficult airway, restricted neck movement and anatomical deformities. We wanted to assess the efficiency and adequacy of combined topical anaesthesia and regional nerve blocks in awake nasal intubation for dental surgeries.

METHODS

 After approval of the study by the ethical committee of the hospital, a prospective observational study was done on 35 adult patients with ASA grade I-II. A written informed consent was obtained from each patient. A preoperative evaluation including a complete airway assessment was done. According to standard guidelines premedication was given. The efficiency and adequacy of combined topical anaesthesia and nerve blocks in awake nasal intubation is assessed for dental surgeries using Intubation Score, Patient’s Comfort Score, Intubation Time, Intubation Attempt and Patient’s Satisfaction Score.

RESULTS

In our study, we observed an increase in HR, SBP, DBP and mean arterial pressure during intubation (maximum seen at the time of tracheal intubation), which later on settled until the 3^rd and 4^th min after intubation was done. In our study, the efficiency and adequacy of blocks given were assessed by using intubation scores which included (a) cough score (b) limb movements which showed successful application of block in around 80% of patients. The further comfort of the patient was assessed by using 5-point patient comfort score during the procedure and 3-point comfort score after awake intubation. Patient satisfaction score was assessed postoperatively, and majority of patients showed excellent satisfaction score.

CONCLUSIONS

Awake nasotracheal intubation done under topical anaesthesia and combined regional nerve blocks is associated with good intubating conditions and patient comfort with minimal effect on hemodynamics.

KEY WORDS

Awake Nasal Intubation, Topical Anaesthesia, Superior Laryngeal block, Transtracheal Block, Bupivacaine, Xylometazoline