Effects of dexmedetomidine and lidocaine on ease of intubation during awake fiberoptic intubation using nebulization versus spray-as-you-go in adult temporomandibular ankylosis: a randomized double-blind trial

Background When administering anesthesia to temporomandibular joint (TMJ) ankylosis patients, it is important to have a flexible fiberoptic bronchoscope and qualified personnel for operation and monitoring. Aim This work aimed to estimate the effectiveness of topical anesthesia on airway with nebulization to the spray-as-you-go method which uses a mixture of dexmedetomidine and lidocaine for achieving upper airway anesthesia in adult patients with TMJ Ankylosis. Patients and methods A randomized double-blinded trial was carried out on 70 patients, aged from 21 to 65 years, both sexes, with TMJ ankylosis underwent elective corrective surgery requiring general anesthesia. Patients were separated equally into two groups (all received a combination of 10 ml of 2% lidocaine and 1 μg/kg dexmedetomidine) via nebulization in group N, while via spray-as-you-go procedure in group S. Results There was insubstantially variation among both groups as regard time till successful intubation ( P >0.05). Ease of successful intubation (composite score) was substantially reduced in group N than group S ( P <0.05). The sore throat was substantially reduced in group N than group S at postoperative care unit, 1 h and 12 h ( P <0.05). Sore throat did not take place at 24 h in every patient in both groups. Conclusion Both nebulization and spray-as-you-go techniques, using a mixture of dexmedetomidine and lidocaine, showed similar effectiveness in time till successful intubation, and maintaining hemodynamic stability during awake fiber-optic intubation (AFOI) in TMJ Ankylosis patients. However, nebulization was easier for intubation, while the spray-as-you-go method led to a higher incidence of postoperative sore throat.