This prospective randomized controlled trial aims to compare the effectiveness of airway nerve blocks versus nebulized lidocaine in attenuating hemodynamic responses during awake fiberoptic intubation in adult patients with anticipated difficult airways. Eighty patients undergoing elective surgery requiring awake fiberoptic intubation will be randomly assigned to receive either airway nerve blocks (glossopharyngeal and transtracheal blocks with lidocaine) or nebulized lidocaine. The primary outcome will be changes in heart rate and mean arterial pressure during and after intubation. Secondary outcomes include intubation conditions, patient comfort, cough severity, intubation time, and procedure-related complications. The study aims to identify the most effective airway anesthesia technique for maintaining hemodynamic stability and improving patient tolerance during awake fiberoptic intubation.
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Parallel
Nebulized Lidocaine
DrugParticipants will receive 4% lidocaine administered via nebulization for 15 minutes before awake fiberoptic intubation to provide topical airway anesthesia and suppress airway reflexes during the procedure.
Nerve Block
Procedure/SurgeryParticipants will receive airway anesthesia using bilateral glossopharyngeal nerve block and transtracheal block with 2% lidocaine before awake fiberoptic intubation to provide airway anesthesia and suppress airway reflexes during the procedure.
Mean Arterial Pressure (MAP) Change During Awake Fiberoptic Intubation
Change in mean arterial pressure from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation.
Heart Rate Change During Awake Fiberoptic Intubation
Change in heart rate from baseline measured during intubation and at 1, 3, and 5 minutes after awake fiberoptic intubation.
Intubation Time
Time from insertion of the fiberoptic bronchoscope until confirmation of successful endotracheal tube placement.
Patient Comfort Score
Patient comfort assessed using a standardized 5-point tolerance scale.
Cough Severity Score
Severity of coughing during awake fiberoptic intubation assessed using a predefined cough scoring system.
Successful Intubation Rate
Successful placement of an endotracheal tube without the need for rescue airway anesthesia.
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