Indigenous technique of airway topicalization for awake videolaryngoscopy
Dheeraj Kapoor, Jasmine Kaur Narula, Deepanshu Rai, Manpreet Singh, Akanksha KumariBackground:
Topicalization of the airway is crucial for managing difficult airways, particularly in uncooperative or emergency surgical patients. While peripheral nerve blocks are effective, they require patient cooperation and time, making them impractical in certain cases. Awake video-laryngoscopy (VL) is increasingly utilized due to its ease and minimal resource requirements. However, achieving adequate airway anesthesia for awake VL poses challenges, especially with hyperangulated blades.
Methods:
We propose an indigenous modification of the spray-as-you-go technique, tailored for CMAC D-Blade videolaryngoscopy. We introduce a method for the simultaneous instillation of local anesthetic (LA) by utilizing the side channel of the D-Blade, meant for paraoxygenation and suctioning. We inserted an infant feeding tube within the standard oxygen tubing attached to the oxygen source to facilitate LA spread in a 360° area around the tube, enhancing the effectiveness. Oxygen serves as a carrier for LA dispersion and simultaneously provides paraoxygenation, both beneficial in patients with difficult airways and compromised respiratory function.
Conclusion:
This modification overcomes the limitations of traditional methods of topicalization by ensuring effective LA distribution along the VL entry line and surrounding hypo- and laryngopharynx. Our approach offers a practical solution for awake VL-guided tracheal intubation, potentially improving patient comfort and procedural success.