Canadian Journal of Anesthesia, Vol 21, 467-474, Copyright © 1974 by Canadian Anesthesiologists' Society

Intubation Under Topical Supra-Glottic Analgesia in Unpremedicated and Non-Fasting Patients: Amnesic Effects of Sub-Hypnotic Doses of Diazepam and Innovar®

¹ Department of Anesthesia, Brugmann Hospital, and Brussels University, Brussels, Belgium
² Staff Anesthesiologist, Brugmann Hospital, Brussels

We have studied the retention of cough and glottic closure reflexes and the quality of the amnesia produced by subhypnotic doses of Innovar and diazepam given before intubation of non-fasting and unpremedicated patients. Twenty-five patients received one or more injections of diazepam (2 to 25 mg) and Innovar® (0 to 4 ml) before and during the application of topical analgesia under direct laryngoscopy. Very selective analgesia is produced by spraying lignocaine 10 per cent on the pillar of the right tonsil, the base of the tongue, the oropharynx and the anterior surface of the epiglottis. The laryngeal and tracheal cough reflexes and the glottic closure reflex were retained in each patient. Movements of head, extremities and trunk were present in patients at intubation. The time required for intubation varied from one to nine minutes with a mean of 4'7'' ± 30''. Amnesia for the intubation is constant and excellent. No patient remembered coughing. Patients did not consider the techniques unpleasant. Preservation of the cough reflex contraindicates the method in some special circumstances such as fracture of the skull with an open dura, perforating wounds of the eye, prolapse of the cord, tension pneumothorax and cardiac tamponnade.