A Comparison of Two Minimally Invasive Techniques of Topicalization for Awake Fiber-optic Intubation in Patients with Oral Malignancies – A Double-blind Randomized Study
Mamta Dubey, Soumi Pathak, Nitesh GoelAbstract
Background and Aims:
Successful topicalization for awake fiber-optic intubation (AFOI) requires blocking both the superior and recurrent laryngeal nerves. In our study, we evaluated the efficacy of 2% lidocaine jelly for adequate supraglottic anesthesia during AFOI and compared it with 4% lidocaine nebulization. The primary objectives were to evaluate the quality of airway anesthesia, assess patient comfort, and evaluate postoperative patient satisfaction. The secondary objectives were to quantify the amount of lidocaine jelly used, measure the serum lidocaine levels in the jelly group, and identify any complications.
Methods:
In this prospective, double-blind, randomized study, 60 patients with oral malignancy requiring AFOI were randomized to receive either 4% lidocaine nebulization or 2% lidocaine jelly instillation. The parameters observed were intubating conditions, patient comfort and satisfaction, the total lidocaine dose required, and any side effects.
Results:
Two percent lidocaine jelly was associated with good-to-excellent intubating conditions in approximately 80% of patients and high patient satisfaction scores. The average lidocaine jelly requirement was 5.26 mg/kg. Serum levels of lidocaine after jelly instillation were 2.09 ± 0.84 mg/ml, which was well within the normal range. The average time for topicalization was significantly shorter with 2% lidocaine jelly (6.7 vs. 22.2 min) than with nebulization.
Conclusion:
Two percent lidocaine jelly has a rapid onset of action and requires no additional equipment or landmark identification, making it suitable for topicalization in emergencies, oncology practice, and low-resource settings. As with any topicalization technique, it should be performed in a controlled environment to allow immediate intubation.