Awake fiberoptic orotracheal intubation: a protocol feasibility study

Abstract

Objective To assess the feasibility of an awake fiberoptic intubation (AFOI) protocol. Methods We enrolled 40 patients with simulated difficult intubation. The protocol consisted of conscious sedation (midazolam, 0.03 mg/kg and sufentanil, 0.1 µg/kg), regional anesthesia, and intubation. The time, first-attempt intubation success rate, hemodynamic parameters, blood oxygen saturation (SpO2), intubation amnesia rate, patient satisfaction, and relative complications were recorded. Results AFOI was completed in all patients. The average total AFOI time was 14.17 ± 1.47 minutes, and the time to placing the landmark-guided bilateral superior laryngeal nerve block was 1.24 ± 0.42 minutes. The first-attempt intubation success rate was 97.5%, and patient satisfaction was 90%. Blood pressure changed (<20%) briefly after administering conscious sedation. Heart rates did not change significantly, and SpO2 remained stable and ≥95%. Three patients had a sore throat, which resolved on postoperative day 1 without other complications. On postoperative day 1, 82.5% (33/40) of the patients had no recall of AFOI, and 17.5% (7/40) had only an indistinct memory. Conclusions The protocol was feasible with a high first-attempt intubation success rate and low complications rate. Hemodynamic parameters and respiration remained stable, with high patient satisfaction and effective amnesia.

Clinical Application of Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block in Patients with Severe COPD Undergoing Awake Fibreoptic Nasotracheal Intubation: A Randomized Controlled Clinical Trial

“…Although there have been few clinical trials, our results are basically similar to previous studies. Ma et al 40 reported that the hemodynamic parameters and respiration remained stable in awake fibreoptic orotracheal intubation under SLN block. In a prospective randomized clinical study, Ambi et al 26 showed that HR and MAP were significantly more stable in the ultrasound group.…”

Learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents: A cumulative sum analysis

“…Flexible bronchoscope-guided intubation can be performed nasally or orally in awake patients with topical or regional anesthesia alone, or in sedated or anesthetized patients. The nasal route is often used on patients with poor mouth opening or a large tongue as it courses past the nasopharynx with less obstruction by the tongue [ 21 ]. Awake flexible bronchoscope-guided intubation is strongly recommended in patients with anticipated difficult airways [ 2 , 6 , 22 , 23 ].…”

A propensity score-adjusted analysis of efficacy of high-flow nasal oxygen during awake tracheal intubation

“…This might exacerbate intubation difficulty and eventually increase the risk of hypoxia in patients whose airways are difficult to manage 4 . Therefore, awake tracheal intubation (ATI) is the gold standard for such patients 8 . The Difficult Airway Society recommended supplemental oxygen during ATI at the Grade B level 9 .…”