COMPARISON OF TWO TECHNIQUES OF LOCAL ANAESTHESIA I.E. TRANSTRACHEAL INJECTION AND SPRAY AS YOU GO TECHNIQUE FOR FIBEROPTIC INTUBATION – A CLINICAL STUDY

Abstract

Fiberoptic aided intubation of trachea is an established and less stimulating technique for obtaining a secure airway in patients for whom standard direct laryngoscopy is difficult or unsafe for intubation. It can be performed through oral or nasal route efficiently as it
contains flexible fiberoptic bundle. The components of a fiberoptic bronchoscope(1) include, an eyepiece on top and a control section, which include of angulation lever, a suction port and a working channel port. An image is transmitted through the length of the scope by an organized coherent bundle of fibers that have the exact orientation at both ends of the scope. The transmission of visual image through a flexible fibreoptic bundle was first reported in 1954(2). Since then it is used in anticipated difficult airways(3) identified on the basis of predictive airway tests, history of difficult or failed intubation and patient characteristics, e.g. obstetrics, morbid obesity and in unanticipated difficult airways as a primary or secondary ‘rescue’ techniques for tracheal intubation. It provides diagnostic
information before deciding on subsequent airway management plan. It is preferred in patients with poor dentition and loose teeth and in patients with high risk of aspiration where awake technique is advantageous. In unstable cervical spine or vertebrobasilar artery
insufficiency it allows repeat neurological assessment after intubation and operative positioning before induction of general anaesthesia. It is also used for confirming the position of airway devices, assessing endotracheal tube depth, tracheostomy insertion and positioning, double lumen tube and bronchial blocker placement and depth assessment.