Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

Area of Science:

• Anesthesiology
• Pulmonology
• Medical Devices

Background:

• Awake tracheal intubation requires patient cooperation, which can be compromised by sedation or airway reflexes.
• Topical airway anesthesia, particularly the spray-as-you-go technique, is a common method for managing airway anesthesia.
• Coughing and gagging reflexes during local anesthetic application are common challenges.

Purpose of the Study:

• To evaluate the efficacy of using oxygen flow to atomize local anesthetic during awake tracheal intubation.
• To assess the impact of this technique on patient cooperation and airway reflexes.
• To determine the safety profile of high-flow oxygen during this procedure.

Main Methods:

• Utilized a spray-as-you-go technique with local anesthetic applied through a flexible endoscope's working channel.
• Employed high-flow oxygen (10 L/min) via an atomizer to create a fog of anesthetic particles.
• Monitored for patient reflexes, cooperation, airway view, and potential complications.

Main Results:

• High-flow oxygen effectively fogged the local anesthetic, reducing coughing and gagging reflexes.
• Improved patient satisfaction and cooperation were observed.
• Enhanced visualization due to dispersed secretions and blood.
• No significant complications such as gastric insufflation or barotrauma were reported.

Conclusions:

• Atomizing local anesthetic with high-flow oxygen is a simple, effective method to improve patient cooperation during awake tracheal intubation.
• This technique enhances airway visualization and minimizes adverse reflexes.
• The described setup allows for complication-free use of high oxygen flow.