Ultrasound‐Guided Airway Nerve Blocks vs. Lidocaine Topical Anesthesia Using Video‐Assisted Laryngoscopy in Suspected Difficult Intubation for Patients Undergoing Bariatric Surgery: A Randomized Clinical Trial

Introduction Anesthetic complications related to difficult airways in obese patients are very common, necessitating the need for an ideal method of awake intubation, either airway block anesthesia or topical anesthesia. The Aim of This Work To compare topical airway anesthesia with airway nerve block for ease of awake intubation, with the C‐MAC video laryngoscope device employed in difficult intubation anticipated in patients undergoing bariatric surgery. Ease of intubation has been assessed by comparing gag reflex, cough reflex, patient comfort, and other factors. Patients and Methods This study has been conducted on 80 obese patients undergoing bariatric surgery, where 40 patients received airway nerve block Group LA and 40 patients received topical anesthesia by the method of spray as you go for anesthetizing the airway using 10% lidocaine spray Group T , in addition to conscious sedation before video‐assisted laryngoscopy. Result Group LA showed better airway conditions with decreased cough and gag reflexes, and more patients were intubated at the first attempt than in Group T . Intubation time and need for a rescue airway were less in Group LA. Patient comfort and experience, by recall absence and lower Visual Analog Scale (VAS) scores, were better for Group LA in comparison with Group T . Adverse events in terms of heart rate (HR), elevated mean blood pressure (MAP), and desaturation episodes were more common in Group T . Conclusion This study concluded that ultrasound‐guided airway nerve blocks provided shorter intubation time, significantly superior airway conditions, and more stable hemodynamic and oxygenation profiles compared to topical lidocaine spray, with fewer airway‐related complications, reduced need for rescue interventions, and higher overall comfort with no recall of the procedure. Trial Registration: ClinicalTrials.gov identifier: NCT07069686