A technique of awake fibreoptic intubation

Sldhu, V.S.; Whltehead, E.M.; Ainsworth, Q.P.; Smith, Martin; Calder, Ian

doi:10.1111/j.1365-2044.1993.tb07429.x

Cited by 48 publications

(7 citation statements)

References 24 publications

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“…These include, but are not limited, to the following: Compromised airway, restricted or limited neck movement,[ 14 15 ] anatomic deformities, and in general anesthesia where intubation may become highly difficult and challenging in the face of the difficult airway. The difficult airway algorithm which includes a call for help in such a scenario may not be applicable in this case as we do not have much time left after paralyzing the patient.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

et al. 2016

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Aims of Study:To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks.Materials and Methods:In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine.Results:Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades.Discussion:The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique.Conclusion:A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.

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Section: Discussionmentioning

confidence: 99%

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

et al. 2016

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“…Studies with observational findings reported successful awake intubation in 88 to 100% of anticipated difficult airway patients (Category B3-B evidence ). 224–227 Case reports for awake intubation ( e.g. , blind tracheal intubation, intubation through supraglottic devices, optically guided intubation) also observed success with anticipated difficult airway patients (Category B4-B evidence).…”

Section: Anticipated Difficult Airway Managementmentioning

confidence: 99%

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

670

547

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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“…Oxygen administration (10 L/minute) was thus performed via a suction catheter inserted from the "second mouth." The incidence of desaturation (SpO 2 ≤ 90%) with low-flow (<30 L/minute) oxygen administration during awake intubation ranges from 12% to 16% [13][14][15]. In the present case, however, SpO 2 was maintained at 99%-100% throughout the airway management.…”

Section: Discussionmentioning

confidence: 51%

“…However, in this patient, oxygen administration via a nasal cannula was not performed because of his severe facial injuries [ 2 , 10 ], although no basilar skull fractures were shown in the preoperative computed tomography. Oxygen administration (10 L/minute) was thus performed via a suction catheter inserted from the “second mouth.” The incidence of desaturation (SpO 2 ≤ 90%) with low-flow (<30 L/minute) oxygen administration during awake intubation ranges from 12% to 16% [ 13 - 15 ]. In the present case, however, SpO 2 was maintained at 99%-100% throughout the airway management.…”

Section: Discussionmentioning

confidence: 99%

Airway Management of a Patient With Penetrating Maxillofacial Trauma Caused by Chainsaw Kickback: A Case Report

Wakabayashi

2023

Cureus

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Anesthesiologists rarely experience airway management in patients with maxillofacial injuries caused by a chainsaw. A 36-year-old male was referred to our hospital because of maxillofacial injuries caused by chainsaw kickback. There were deep lacerations of the right eyelid, medial canthus, cheek, and jaw with venous bleeding. The laceration of the cheek reached the oral cavity and looked like a "second mouth." The patient was taken to the operating room for urgent laceration repair under general anesthesia. Despite a poor laryngeal view, awake orotracheal intubation with a videolaryngoscope was successful on the second attempt without complications. Oxygenation was optimized by supplemental oxygen administration via a suction catheter inserted from the "second mouth" throughout the airway management. The present case highlights the importance of airway management strategies according to the nature of the trauma in patients with penetrating maxillofacial trauma caused by a chainsaw.

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A technique of awake fibreoptic intubation

Cited by 48 publications

References 24 publications

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

Airway Management of a Patient With Penetrating Maxillofacial Trauma Caused by Chainsaw Kickback: A Case Report

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