Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway*

Abstract

SummaryAwake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2-15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s.

Lesão brônquica e pneumotórax após reintubação usando um cateter para troca da via aérea

“…Patients with cancer, particularly those with head and neck cancer, represent a group with a higher incidence of diffi cult-to-intubate situation as compared to the general population 3 . The airway exchange catheter is an effective and secure way to perform reintubation of patients with diffi cult airway.…”

Anaesthetic management of acute airway obstruction

“…(99)(100)(101) However, in severe AAO, AFOI should be avoided, due to a number of factors. AFOI requires a calm, cooperative patient, which is unlikely in severe AAO.…”

Pentax-AWS video laryngoscope for tracheal intubation in a patient with Klippel-Feil syndrome

“…Awake fiberoptic bronchoscope (FOB)-guided intubation is known as the safest technique for tracheal intubation in patients with a diagnosed difficult airway [2]. Johnson et al [3] stated that tracheal intubation with fiberoptic bronchoscopy had a high failure rate in the first attempt (approximately 53.3%) , which means it requires great skills and a lot of experience.…”

“…In most cases, a fiberoptic bronchoscope is commonly used when tracheal intubation is expected to be difficult. However, fiberoptic bronchoscopy in emergency situations can be difficult because it requires a lot of skill to perform and involves a long set-up time, and consequently entails high failure rates [2]. On the other hand, the AWS is easily handled with just brief training compared to the fiberoptic bronchoscope.…”