Awake fibrecapnic intubation in head and neck cancer patients with difficult airways: new findings and refinements to the technique*

Abstract

SummaryRecently, we described an adaptation of awake fibreoptic intubation that we call awake fibrecapnic intubation. The aim of this study was to evaluate the efficacy and risk of complications with this novel technique in a consecutive case series of head and neck cancer patients known to have difficult airways.We prospectively studied 40 consecutive intubations in head and neck cancer patients prior to a diagnostic or surgical procedure. Following topical anaesthesia, a flexible bronchoscope was introduced into the pharynx; spontaneous respiration was maintained in all patients. A special suction catheter was advanced into the airway through the suction channel of the bronchoscope for carbon dioxide measurements. When four capnograms were obtained, the bronchoscope was railroaded over the catheter and a tracheal tube was placed. All adverse events and complications were recorded.There were no complications associated with the technique. The median (range) time to intubation was 3 min (1.5-15 min). All patients were intubated successfully, 39 (98%) of them using awake fibrecapnic intubation. There was one patient with severe tumour bleeding and acute airway obstruction caused by advancement of the tube over the bronchoscope. This was not considered to be a complication of the fibrecapnic technique. Awake fibrecapnic intubation is a safe and valuable technique in head and neck cancer patients with a difficult airway. We recently described a novel intubation technique 'Awake Fibrecapnic Intubation' (AFcI) [1]. This technique was developed for the intubation of head and neck cancer patients with a difficult airway. It is an adaptation of fibreoptic intubation. A suction catheter is advanced through the working channel of the bronchoscope and repeated carbon dioxide measurements are possible. With this technique, safe intubation is possible when visibility of pharyngeal and laryngeal structures is limited or the anatomy is unrecognisable. In cases of severe airway obstruction, the suction catheter will enter the trachea before the tip of the bronchoscope occludes the airway. We wish to report a further 25 patients and describe some new findings and refinements to the technique.The aim of the current study was to evaluate the efficacy and risk of complications in a consecutive series of 40 intubations. The first 15 intubations that were previously described are included in this consecutive case series [1].

The evolution of specialist societies into national research networks: a possible solution to the ‘translation problem’

“…I read with interest the report of awake fibrecapnic intubation by Huitink et al [1]. It does, at first glance, seem to be a novel new approach in managing the patient with a known difficult airway.…”

“…I read with interest the recent study by Huitink et al on awake fibrecapnic intubation in patients with head and neck cancer and a difficult airway [1]. I would like to make some comments.…”

“…In his excellent editorial on translational research and anaesthesia, Professor Shorten correctly describes that the problem of perception with anaesthetic research is one potential threat to the academic effort of the specialty [1]. National Health Service Research and Development (NHS R & D) takes the view that research for patient benefit is best undertaken by properly organised national research networks, as these can deal efficiently with the (new) issues surrounding research governance, ethics and clinical trials directives [2].…”

Progress in management of the obstructed airway

“…Awake 'fibrecapnic' intubation [23] has been described as a technique in which a very narrow catheter is passed through the suction channel of a bronchoscope and advanced into the airway for carbon dioxide measurement. When capnography has confirmed the catheter position, the fibrescope is railroaded over the catheter and then the tracheal tube passed in turn over this.…”

“…When capnography has confirmed the catheter position, the fibrescope is railroaded over the catheter and then the tracheal tube passed in turn over this. This technique may still cause total airway obstruction with advanced glottic disease, and with severe tumours bleeding and acute airway obstruction can occur [23].…”