Preparation of the Patient for Awake Intubation

Artime, Carlos A.; Sanchez, Antonio

doi:10.1016/b978-1-4377-2764-7.00011-7

Cited by 9 publications

(9 citation statements)

References 107 publications

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“…The topical anaesthesia of airway mucosa using atomisers, nebulisers, ‘spray-as-you-go’ technique and transtracheal injections, is an alternative to the complex nerve block techniques for aiding AFOI in patients with anticipated difficult airway. [ 1 ] All of the patients in our study had anticipated difficult airway and most of them had head and neck malignancies affecting the airway directly or indirectly after a surgery with or without flaps or radiotherapy. We have observed that most patients of Group T showed a significant reduction in the cough reflex induced on passing the scope to the trachea (25% vs, 88.24%, P = 0.001, Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, being an invasive technique, transtracheal injection has certain concerns such as higher apprehension and lower acceptability among patients, bleeding from the trachea, accidental injection of LA into major vessels and LA toxicity. [ 1 2 ]…”

Section: Discussionmentioning

confidence: 99%

“…Fibreoptic intubation is indicated for patients with anticipated difficult airway because of airway pathology, anatomical variations, airway trauma, morbid obesity or unstable cervical spine. [ 1 2 3 ] Awake fibreoptic intubation (AFOI) is technically challenging even for the experienced anaesthesiologists and often uncomfortable for the patients. Inadequate topical anaesthesia of the airway may make the intubation impossible or lead to crisis from aspiration or breath holding leading to desaturation.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

et al. 2017

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Background and Aims:Successful awake fibreoptic intubation (AFOI) depends on adequate topical anaesthesia of the airway. We aimed to compare efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for AFOI.Methods:It was a prospective, randomised controlled study of 33 patients with the American Society of Anesthesiologists’ physical status 1–3 with anticipated difficult airway requiring AFOI. The primary objective was to compare the patient comfort after topical anaesthesia of the airway using atomiser with transtracheal injection of the local anaesthetic agent for AFOI in patients with anticipated difficult airway. The secondary objectives were to compare the ease of intubation, time required to intubate and the haemodynamic changes during intubation. After topical anaesthesia of nostrils, patients in Group T received transtracheal injection of 4 ml of 4% lignocaine whereas Group A patients received 4-5mL of 4% atomised lignocaine using DeVilbiss atomiser before AFOI. Patient comfort assessed objectively by the anaesthetic assistant during the procedure, ease of intubation assessed using cough and gag reflex score, time taken to intubate and the haemodynamic changes during the procedure were compared.Results:Ease of intubation, patient comfort and the time taken to intubate were significantly better in Group T patients, with P = 0.001, 0.009 and 0.019, respectively, compared with the patients in Group A. There were no significant changes in haemodynamic parameters.Conclusion:Topical anaesthesia by transtracheal injection in patients with anticipated difficult airway made AFOI easier and faster with better patient comfort compared to atomiser with no clinically significant untoward side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

et al. 2017

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“…Aerosolized local anesthetics (4% lidocaine nebulized at 6 to 8 L/min) are used with a high degree of success in most patients. 41 Two validated methods for "awake intubation" exist.…”

Section: Awake Intubation In Obesementioning

confidence: 99%

Airway Management in Patients With Morbid Obesity

Wadhwa

Singh

Sinha

2013

International Anesthesiology Clinics

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“…Atropine 20 µk g -1 IM was given one hour preoperatively to get dry upper airway for more successful FOB service [10,12] through preventing the formation of new secretions and getting enough time (at least 30 min) to eliminate the already formed secretions [13].…”

Section: Tablementioning

confidence: 99%

Nasal fiberoptic intubation with and without split nasopharyngeal airway: Time to view the larynx & intubate

El-Tawansy

nofal

Elsamad

et al. 2018

Egyptian Journal of Anaesthesia

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Background: Fiberoptic intubation requires long nasopharyngeal journey and mostly requiring jaw thrust to visualize larynx especially if done under general anesthesia. Use of split nasopharyngeal airway of appropriate length for better glottis visualization has been compared with the classic one. Methods: Adult 68 patients; ASA I and II; undergoing surgery under general anesthesia were allocated randomly and equally into CL group in which classic nasal FOI with jaw thrust was done and NP group in which appropriate length of SNPA was inserted nasally followed by insertion of the scope with the application of jaw thrust if needed. Preprocedural heart rate, blood pressure and saturation and every minute for 5 min and also procedure and endoscopy time required to visualize the larynx (T1 and T3 respectively), carina (T4) and to remove the scope (T5) were recorded. Results: Heart rate showed a statistically significant increase in CL and NP group during study time compared to pre-procedure reading. The MAP showed also statistical increase but only in CL group. There was a statistical (not clinical) significant increase between the percent of HR and MAP change in the CL group compared to NP group. T1, T3, and T5 in NP group were significantly shorter than in CL group but not for T4. Seven cases after SNPA needed jaw thrust. Conclusion: Use of SNPA is safe and effective in reducing time to visualize larynx and intubate trachea. Developing longer specific "Naso-laryngeal (not nasopharyngeal) FOB intubating aid" is assumed to be more appropriate.

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Preparation of the Patient for Awake Intubation

Cited by 9 publications

References 107 publications

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

Airway Management in Patients With Morbid Obesity

Nasal fiberoptic intubation with and without split nasopharyngeal airway: Time to view the larynx & intubate

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