Comparative Study of Spray-as-you-go Technique Using 2% versus 4% Lignocaine for Awake Fibre-optic Nasotracheal Intubation in Adult Oral Carcinoma Patients: A Randomised Controlled Study

Background and Aims: Managing a difficult airway is a significant challenge for anaesthesiologists, with awake fibre-optic intubation being a highly effective technique. This study compares the ease of intubation using 2% versus 4% lignocaine through a spray-as-you-go (SAYGO) technique for patients undergoing oral carcinoma surgery under general anaesthesia. The primary objective was to evaluate patient tolerance, as measured by their reactions, coughing and gagging, between the two groups. The secondary objectives included assessing vocal cord movement, patient satisfaction, the number of intubation attempts, total intubation duration, haemodynamic changes and post-operative adverse events. Methods: The study recruited 60 patients aged 18–60 years with Mallampati grade III or IV who underwent oral cancer surgery under general anaesthesia. Group 1 received a 2% lignocaine spray, whereas Group 2 was administered a 4% lignocaine spray using the ‘SAYGO’ method. Patient satisfaction and reactions, including gagging and coughing, were evaluated. A significance level of P < 0.05 was established for the analysis. Results: In Group 1, 57% of patients exhibited no reaction, compared to 70% in Group 2 ( P = 0.2997). For coughing, 60% patients of Group 1 and 70% of Group 2 reported no cough ( P = 0.4207). Furthermore, 57% patients of Group 1 and 73.3% of Group 2 experienced no gagging ( P = 0.1889). Satisfaction ratings revealed that 46.6% patients of Group 1 rated their experience as excellent, whereas 53% patients of Group 2 did the same; the remaining patients categorised their experience as good. Conclusion: The 2% lignocaine solution offers effectiveness like the 4% solution for topical anaesthesia during flexible bronchoscopy, requiring a lower dosage.