Flores medical - multisonic - Inhalation mit Ultraschall

Local anaesthesia

Securing the airway during general anaesthesia in patients with difficuIt-to-manage airways poses a risk to the patient and presents challenges for the anaesthesiologist.

Awake fibreoptic intubation is the safest approach to airway management in patients with known difficult airway. Procedures not involving sedation may require to give the patients detailed verbal explanations for them to be able to cope with the emotional stress, but allow full patient cooperation. And with the patient cooperative, intubation is much easier.

However, intubation is usually carried out under topical anaesthesia or light sedation. Upper airway anaesthesia should be administered to a level sufficient to suppress the gag, swallow and cough reflexes, and to avoid painful moments.

There are many ways of administering anaesthesia for fibreoptic intubation via the oral or nasal route. Systemic analgosedation, topical and regional anaesthesia, as well as combinations thereof are used.
Preparations for nasotracheal intubations should include instilling a vasoconstrictor into the nasal cavities in order to reduce mucosal edema.

Glossopharyngeal and superior laryngeal nerve blocks are often difficult to perform and may involve damage to nerves, whereas high doses up to the maximum dose of topical anaesthetics may be needed if the agents are administered in the form of gargles, sprays, lozenges, creams, or impregnated swabs. None of these two approaches effectuates an anaesthesized trachea distal to the glottis. Topical administration of anaesthetic agents makes it difficult to say whether or not the larynx was adequately anaesthesized. Laryngeal anaesthesia may be provided by translaryngeal injection, via the working channel of the flexible bronchoscope, or via a (e.g. epidural) catheter inserted therethrough at end-exspiration and under the anaesthesiologist’s direct vision. Both methods are likely to induce cough in the patient.

A solution to the problem is to nebulize the locally applied anaesthetic. Customary compressed-air driven jet nebulizers only atomize highly concentrated anaesthetics (e.g. lidocaine 4-10%), so that the maximum dose of local anaesthetic is achieved within a short period of time.

We describe the use of an ultrasonic nebulizer (Flores medical GmbH, Probstzella, Germany), that has been designed to deliver liquid medication in the form of a very fine mist containing droplets with an average diameter of just 3.5 urn to the airways. Ultrasonic nebulizers are often used in the treatment of pulmonary hypertension [9]]. An adapter that is to be fit to the nebulizer enables its easy integration into the breathing circuit. This arrangement involving integrating the nebulizer device into the anaesthesia breathing circuit comprising a customary breathing mask which the patient himself/herself holds over the mouth and nose provides the delivery of a sufficient dose of local anaesthetic only during inspiration as well as optimum pre-oxygenation.

In the practice-use, suppression of gag and cough reflexes was obtained by using 100 mg of lidocaine. Thanks to the active cooperation of the patients, i.e. they stuck out their tongues and raised the floor of the mouth the pharyngeal lumen was fully open. This manoeuvre has essentially improved the view during endoscopy and made it so much easier to perform intubation.

The procedure was described in an abstract, that was introduced at the ESA congress in Copenhagen in May 2008.

InfraControl mit Maske direkt
InfraControl mit Gaensegurgel und Maske
InfraControl Bronchoskopie