Efficacy of Atomized Versus Transtracheal Lignocaine (4%) for Awake Flexible Endoscopic Intubation Prospective Randomized Clinical Study

Background: Achieving adequate airway anesthesia is essential for patient comfort and safety during awake flexible endoscopic intubation. Atomized and transtracheal lignocaine represent two widely used techniques with differing invasiveness and efficacy. Objective: To compare the efficacy, patient comfort, and hemodynamic stability between atomized and transtracheal administration of 4% lignocaine in patients with anticipated difficult airway. Material and Methods: Sixty ASA II–III patients were randomly divided into two groups. Group A received atomized 4% lignocaine via mucosal atomization device, while Group T received 4% lignocaine through transtracheal injection. Parameters recorded included cough and gag reflex, comfort score, time to intubation, and hemodynamic changes. Results: The transtracheal group demonstrated significantly lower cough and gag scores, higher patient comfort, and shorter intubation times, with comparable hemodynamic stability across groups. Conclusions: Transtracheal lignocaine provides superior airway anesthesia and patient comfort compared with atomized application, though atomization remains a valuable non-invasive option.