A Simple Method of Topicalisation to Facilitate Awake Fibreoptic Nasotracheal Intubation: Experience at a Tertiary Care Hospital

Abstract

VII parentheses. The reference styles for different types of publications are presented in the following examples.

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

“…Especially the use of muscle relaxants may cause a situation of "point of no return." In the case of an expected difficult airway, e.g., short neck or hypotonia, an alternative approach to relaxation may be topical lidocaine at the laryngeal inlet (48)(49)(50). Topicalization of the airway involves applying a local anesthetic over an area of mucosa to achieve regional neural blockade.…”

Airway topicalisation via direct injection of local anaesthetic into the lumen of high flow oxygenation devices

“…George Zhong 1,3 and Ryan G Downey 2,3 Awake fibreoptic intubation (AFOI) is an important technique for the management of difficult airways. Effective anaesthesia of airway structures minimises patient discomfort, improves patient cooperation, reduces the need for supplemental sedation and is thus critical to the safety and success of AFOI.…”

“…Another disadvantage of this technique is the potential for increased aerosol generation associated with the use of HFNO devices, a particular concern during the current COVID-19 pandemic. 2 The HFNO topicalisation technique shares some similarities with the technique recently described by Bhalotra, 3 whereby 2% lidocaine solution is directly injected into the oropharynx via a carefully positioned nasopharyngeal airway. However, topicalisation through HFNO devices eliminates the risk of airway trauma associated with nasopharyngeal airway insertion as well as the risk of inadequate topicalisation associated with suboptimal nasopharyngeal airway placement.…”