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Background  Awake intubation is used most commonly in patients with a predicted difcult airway. There are situations where the safest method to secure an airway is to place an endotracheal tube in an awake and spontaneously breathing patient. Our aim was to compare the two modalities, airway nerve blocks and atomized lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic)airway for awake fiberoptic intubation (AFOI).  Methods  A total of 50 patients with anticipated difficult airway requiring AFOI were randomly allocated into two groups. Group A received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal nerve) each with 2 ml of 2% lidocaine and group B received airway anesthesia through atomized lidocaine by LMA MADgic using 10 ml of 2% lidocaine. Fiberoptic guided orotracheal intubation was then performed in both the groups using LMA MADgic as the conduit. The primary outcome measured was intubation time and the secondary outcome included quality of intubation, hemodynamic variables, and any adverse events.  Results  The intubation time was found to be significantly lower in Group A (63.80±7.86 seconds) as compared to Group B (184.96±13.38 seconds) (p=0.0001). The ease of intubation, intubating condition, and patient comfort were better in patients who received airway blocks. Group B had an increased number of coughing/gagging episodes as compared with Group A. Between the two groups, group A showed better hemodynamics and fewer episodes of desaturation than group B.  Conclusion  Upper airway nerve blocks provide faster intubation, adequate airway anesthesia, and less patient discomfort to aid in AFOI in patients with anticipated difficult airway as compared to topical anesthesia using an atomizer.

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A Comparative Study of Airway Nerve Blocks and Atomized Lidocaine by the Laryngo-Tracheal Mucosal Atomization Device (LMA MADgic) Airway for Oral Awake Fiberoptic Intubation