Clinical Application of Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block in Patients with Severe COPD Undergoing Awake Fibreoptic Nasotracheal Intubation: A Randomized Controlled Clinical Trial

Abstract

Purpose

The aim was to investigate the time for intubation, adverse events and the comfort score of ultrasound-guided internal branch of superior laryngeal nerve block in patients with severe chronic obstructive pulmonary disorder (COPD) undergoing awake fibreoptic nasotracheal intubation.

Methods

Sixty patients with COPD who needed awake fibreoptic nasotracheal intubation were randomly and evenly divided into the ultrasound-guided internal branch of the superior laryngeal nerve block group (group S) and the control group (group C). All patients received procedural sedation with dexmedetomidine and adequate topical anaesthesia of the upper respiratory tract. Then, bilateral block was performed (with 2 mL of 2% lidocaine or the same volume of saline) followed by fibreoptic nasotracheal intubation. The primary outcomes were time for intubation, adverse reactions and comfort score. The secondary outcomes were haemodynamic changes and serum norepinephrine (NE) and adrenaline (AD) concentrations immediately before intubation (T0); immediately after intubation to the laryngopharynx (T1); and immediately (T2), 5 min (T3) and 10 min (T4) after intubation between the groups.

Results

Compared with group C, the time for intubation, the incidence of adverse reactions and the comfort score in group S were significantly lower (P<0.01). Compared with T0, the mean arterial pressure (MAP), heart rate (HR), NE and AD were significantly higher at T1 - T4 in group C (P<0.05), but were not obviously higher at T1 - T4 in group S (P>0.05). MAP, HR, NE and AD at T1–T4 were significantly lower in group S than in group C (P<0.05).

Conclusion

Ultrasound-guided internal branch of the superior laryngeal nerve block can effectively shorten the time for intubation, reduce the incidence of adverse reactions, improve comfort score, maintain considerable haemodynamic stability and inhibit stress response in patients with severe COPD undergoing awake fibreoptic nasotracheal intubation.

Keywords:

• COPD
• awake fibreoptic nasotracheal intubation
• the time for intubation
• stress response
• ultrasound-guided the internal branch of the superior laryngeal nerve block

Abbreviations

COPD, chronic obstructive pulmonary disease; ASA, American Society of Anaesthesiologists; UGSLNB, ultrasound-guided superior laryngeal nerve block; UGISLNB, ultrasound-guided the internal branch of the superior laryngeal nerve block; SLN, superior laryngeal nerve; FB, fibreoptic bronchoscope; ECG, electrocardiogram; MAP, mean arterial pressure; BP, blood pressure; HR, heart rate; SPO₂, saturation of peripheral oxygen; DEX, dexmedetomidine; RR, respiration rate; ETCO2, end-tidal carbon dioxide; AD, adrenaline; NE, norepinephrine; PONV, postoperative nausea and vomiting; PaO2, partial pressure of arterial oxygen; FiO₂, fraction of inspiration O₂; PaCO2, partial pressure of arterial carbon dioxide; NIPPV, non-invasive positive pressure ventilation; SD, Standard deviation; ANOVA, analysis of variance.

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon request in 10 months.

Ethical Statement

The authors declare that all patients gave written informed consent before initiation of the study protocol and were conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee of The Second Hospital of Shandong University (No. KYLL-2020LW-057).

Acknowledgments

We would like to thank the participants who enrolled in this study, and the study team for essential contributions. Additionally, we thank Professor Liyuan Liu for her help in statistics.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Clinical research fund of Shandong Medical Association (No:YXH2022ZX02028).