Awake fiberoptic intubation: A narrative clinical review based on the Cleveland Clinic experience

Galway, Ursula; Khatib, Reem; Zura, Andrew; Khanna, Sandeep; Wang, Mi; Thida, Fnu; Ruetzler, Kurt

doi:10.1016/j.tacc.2021.05.006

Cited by 3 publications

(2 citation statements)

References 35 publications

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“…Awake fiberoptic intubation is often indicated when there is anticipated or suspected difficulty in airway management due to abnormal anatomy and altered airway patency (i.e. head and neck tumors), cervical spine instability, and risk for aspiration or inability to tolerate a period of apnea [ 11 , 12 ]. The advantages include keeping the patient spontaneously breathing, improving visualization of vocal cords, and reducing the stimulation of the sympathetic response compared to direct laryngoscopy [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Contraindications to this technique include copious secretions or bleeding, local anesthetic allergy or sensitivity, ongoing hypoxia, inability to cooperate due to intoxication or impaired mental development, and critical airway compromise in patients who may benefit from tracheostomy (maxillofacial fractures for nasal intubation) [ 11 , 12 ]. Complications from awake fiberoptic intubation have ranged from mucus plugging, discovery of cuff leaks after intubation, inadvertent extubation, and multiple intubation attempts to desaturation (due to bleeding, hypoxia from oversedation, and further trauma and possible edema in the supraglottis which may pose airway obstruction) [ 12 ]. Limitations for this technique include experience, training, and skill of the proceduralist performing the intubation.…”

Section: Discussionmentioning

confidence: 99%

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Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

Chowdhury¹,

Cagliani²,

Loyola³

et al. 2023

Cureus

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Ameloblastomas are rare tumors that arises from the odontogenic epithelium. Although benign and slow growing, an extensive lesion may cause airway obstruction, making bag-mask ventilation and intubation a significant challenge. Here, we present a 54-year-old male in respiratory distress with an 18x15x13 cm submandibular mass causing airway compromise. The tumor was extensive, occupying most of the oral cavity. Unable to perform direct laryngoscopy because of the tumor burden, we performed an awake nasal fiberoptic intubation to secure the airway. Successful intubation was achieved as well as subsequently tracheostomy. We subsequently provide a discussion on associated challenges and management options for patients with ameloblastomas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

Chowdhury¹,

Cagliani²,

Loyola³

et al. 2023

Cureus

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Anesthetic considerations for rigid bronchoscopy: A narrative educational review

Galway

Zura

Wang

et al. 2022

Trends in Anaesthesia and Critical Care

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Awake Tracheal Intubation: An Update

Warwick,

Yoon,

Ahmad

2024

International Anesthesiology Clinics

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Awake tracheal intubation (ATI) remains the “gold standard” technique in securing a definitive airway in conscious, self-ventilating patients with predicted or known difficult airways and the procedure is associated with a low failure rate. Since its inception a variety of techniques to achieve ATI have emerged and there have been accompanying advancements in pharmaceuticals and technology to support the procedure. In recent years there has been a growing focus on the planning, training and human factors involved in performing the procedure. The practice of ATI, does however, remain low around 1% to 2% of all intubations despite an increase in those with head and neck pathology. ATI, therefore, presents a skill that is key for the safety of patients but may not be practised with regularity by many anesthetists. In this article we therefore aim to highlight relevant guidance, recent literature and provide an update on the practical methods fundamental for successful ATI. We also discuss the crucial aspects of a safe airway culture and how this can help to embed training and maintenance of skills.

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Awake fiberoptic intubation: A narrative clinical review based on the Cleveland Clinic experience

Cited by 3 publications

References 35 publications

Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

Massive Ameloblastoma Requiring Awake Nasal Fiberoptic Intubation

Anesthetic considerations for rigid bronchoscopy: A narrative educational review

Awake Tracheal Intubation: An Update

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