A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation

作     者：JIANG Hai MIAO Hai-sheng JIN San-qing CHEN Li-hong TIAN Jing-ling 

作者机构：Department of Anesthesia Sixth Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510655 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2011年第124卷第23期

页      面：3997-4001页

核心收录：

学科分类：1002[医学-临床医学] 100217[医学-麻醉学] 10[医学] 

基　　金：This study was supported by grants from the Guangdong Provincial Project for Science and Technique Research (No.2008B080703066) and the Guangdong Provincial Medical Science and Technique Research Foundation (No.A2009526).Conflict of interest:none 

主　　题：anesthesia, local, lidocaine spray intubation, intracheal conscious sedation 

摘      要：Background Difficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven （by 10 L/min oxygen flow） lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation. Methods Thirty adult patients referred for elective surgery under general anesthesia, aged 18-60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer＇s assessment of alert and sedation （OAA/S） scale was controlled between 3 and 4 by intravenous midazolam （0.03 mg/kg）, propofol （2 ***.h＂1） and remifentanil （0.05 ***1）. Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan＇s intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure （MAP）, heart rate （HR） and pulse oxygen saturation （SpO2） were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation. Results All patients were intubated at the first attempt, the average intubation condition score was 7.0＋_1.1, from 6 to 10 satisfied intubation condition. MAP an