A 30-year-old patient with a known difficult airway is scheduled for elective neck surgery. Pre-oxygenation is followed by awake fibreoptic nasotracheal intubation. The drug of choice for topical anaesthesia of the airway for this procedure is:

• A Benzocaine spray to the posterior pharynx
• B Cocaine 10% solution to the nasal mucosa
• C Bupivacaine 0.5% infiltration of the larynx
• D Lignocaine 4% nebulized or applied topically via 'spray as you go' technique ✓

Explanation

Lignocaine 4% is the most widely used agent for airway topicalization prior to awake fibreoptic intubation because it has a rapid onset (2–5 minutes), adequate duration, and an established safe maximum dose for this route (~4 mg/kg). It can be applied via atomizer, nebulizer, gargle, or 'spray-as-you-go' through the fibreoptic bronchoscope. Benzocaine carries a risk of methemoglobinemia; cocaine 10% is used only in nasal procedures due to vasoconstrictor properties; bupivacaine injected into the larynx risks systemic absorption and cardiac toxicity.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.