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Rapid oral anesthesia for awake intubation
1Anesthesia and Operative Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200.
Study Objective:
To determine whether sodium benzonatate (Tessalon Perles) can provide rapid, effective topical oral anesthesia in preparation for awake intubations.
Design:
Randomized, controlled, single-blind study.
Setting:
Medical center anesthesia department.
Patients:
Forty patients counseled for an awake intubation.
Interventions:
The patients were randomized (random permutated block) to receive either benzonatate 200 mg topically for oropharyngeal anesthesia or bilateral superior laryngeal nerve blocks (total 8 ml of 1% lidocaine) in conjunction with 2 ml of 20% benzocaine orally. Both groups were administered 4 ml of 4% lidocaine translaryngeally. If nasal intubation was anticipated, the patients received 6 ml of 2% lidocaine jelly for nasal anesthesia.
Measurements And Main Results:
The time to obtain oropharyngeal anesthesia was measured as the time from obtaining the benzonatate capsules from the bottle or palpation of the neck to locate the hyoid bone to the time when the patient exhibited an absent gag response to an oropharyngeal airway. After completion of airway preparation, the patient's response to intubation was evaluated by an anesthesiologist blinded to the method of preparation. Medications administered for sedation and analgesia were recorded. Noninvasive blood pressure, heart rate (HR), cardiac rhythm, and three-lead ST segments (I, II, V5) were recorded and evaluated for changes from baseline. Postoperatively, the patient was questioned for recall of the intubation. The time required to obtain loss of the gag response was shorter in the benzonatate group (55.1 +/- 5.7 seconds vs 339 +/- 22.4 seconds, p less than 0.005). The patient response to intubation was similar in both groups (90% no response, 10% minimal response). No abnormal cardiac rhythms or ST segment depression occurred, and mean arterial pressure and HR did not increase more than 20%.
Conclusions:
The results of this study indicate that benzonatate capsules provide rapid and reliable oropharyngeal anesthesia in preparation for awake intubation. In addition, if excellent airway anesthesia is provided, awake intubations can be accomplished with minimal patient response and discomfort.