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Airway spray efficacy of local anesthetic with fiberscope
Airway spray efficacy of local anesthetic with fiberscope
Yu‑Hui Wang 0
Fu‑Shan Xue 0
Hui‑Xian Li 0
0 Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144 , People's Republic of China
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To the Editor:
In the recent article by Tsukamoto et al. [1]
assessing airway spray efficacy of local anesthetic with a
fiberscope, an important issue ignored by them is the fact that
the spreading of local anesthetic in the airway is achieved
mainly by a patient’s coughing immediately after injection,
whereas a manikin has no coughing reflexes. In method,
it was unclear whether injection velocity of liquid and air
mixture was comparable with different syringes, though
this factor can significantly affect the spray efficacy of local
anesthetic in the airway [2]. These issues would have made
the interpretation of their findings questionable.
The main aim of injecting local anesthetic and air
mixture is to ensure that all of the injected solution is ejected
from the working channel and adequate spreading of the
injected solution onto the target airway mucosa is achieved.
In fact, the method used most commonly in clinical practice
is that 1 ml of solution plus 9 ml air in a 10-ml syringe is
injected with each spray and a second 10 ml of air is given
immediately after first injection [2]. A multiorifice epidural
catheter through the working channel can also avoid losing
any of the injected solution, provide multidirectional sprays
of local anesthetic, and reduce the stimuli to the airway in
awake patients as the fiberscope’s tip is positioned above
the glottis and airway spray is completed using the epidural
catheter with fiberoptic visualization [3].
Compliance with ethical standards
Conflict of interest None of authors has received financial support
and there are no potential conflicts of interest for this work.
1. Tsukamoto M , Hirokawa J , Yokoyama T. Effective spray for topical anesthesia with fiberscope . J Anesth . 2017 . doi:10.1007/ s00540- 017 - 2331 -5.
2. Simmons ST , Schleich AR . Airway regional anesthesia for awake fiberoptic intubation . Reg Anesth Pain Med . 2002 ; 27 : 180 - 92 .
3. Long TR , Wass CT . An alternative to transtracheal injection for fiberoptic intubation in awake patients: a novel noninvasive technique using a standard multiorifice epidural catheter through the bronchoscope suction port . Anesthesiology . 2004 ; 101 : 1253 . (...truncated)