Topical Airway Anesthesia for Tracheal Intubation Prevents Intraoperative Hypotension and Improves Outcomes in Severe Traumatic Brain Injury by Reducing Anesthesia Induction: A Single-Center, Single-Blinded, Randomized Trial

OBJECTIVES: Anesthesia induction is a key risk factor for intraoperative hypotension due to the cardiovascular system's suppression of induction anesthetics, and intraoperative hypotension significantly affects mortality linked to traumatic brain injury (TBI). Topical airway anesthesia could optimize intubation conditions with less induction anesthetic. This study aimed to determine whether topical airway anesthesia for tracheal intubation can prevent intraoperative hypotension by reducing the need for induction anesthetics in TBI patients. METHODS: A total of 120 patients with severe TBI who underwent craniectomy without preoperative intubation were randomized into the standard anesthesia (C) group or the topical airway anesthesia for intubation (T) group. The patients in the C group received standard anesthesia induction, and those in the T group received topical airway anesthesia without standard induction anesthetics. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at the designated time points. In-hospital mortality, ICU morbidity, ICU stay duration, and neurological outcomes at discharge and 6 months postoperatively were evaluated. Postoperative injury to the heart, kidney, and liver was assessed. RESULTS: A total of 52 patients in the C group and 51 in the T group completed the trial. After intubation, the SBP and DBP in the T group were significantly greater than in the C group (P<0.05). The in-hospital mortality and ICU morbidity rates in the T group were lower than in the C group (P<0.05). The T group also had lower postoperative injury rates to the heart, kidney, and liver in was lower (P<0.05). While neurological recovery at discharge was improved in the T group, the difference was not statistically significant (P>0.05), except for the number of moderate and severe comas (P<0.05). The neurological score at 6 months postoperatively was increased in the T group (P<0.05). CONCLUSIONS: Topical airway anesthesia for tracheal intubation was associated with higher intraoperative blood pressure, lower in-hospital mortality and ICU morbidity rates, and improved neurological outcomes in patients with severe TBI. These findings suggest that reducing induction anesthetics through topical airway anesthesia may be a promising strategy for managing anesthesia in TBI patients, though confirmation in larger multicenter trials is warranted.