Awake Flexible Fiberoptic Intubation (Preview)

Presented by Dr. James DuCanto, Aurora St. Luke’s Medical Center.

In this video, I would like to share with you the technique of topical anesthesia for awake flexible fiberoptic intubation that I employ routinely.

The technique involves application of 4% lidocaine in 3 consecutive steps, before the endotracheal tube is advanced into the patient’s trachea:

1.  First 3 ml: gargle and swallow
2.  Second 3 ml: targeted application on epiglottis and vocal cords (x 2)
3.  Third 3 ml: itratracheal application

I always wait at least 15 seconds for the local to work.

I use minimal sedation during airway topicalization, typically IV Fentanyl 50-75 mcg, and IV Midazolam 2-3 mg total dose. I titrate the drugs carefully to patient’s comfort, and frequently add another IV Midazolam 2 mg after the fiberoptic scope has been placed inside the patient’s trachea.

What technique(s) of upper airway anesthesia do you use for awake intubation? I am looking forward to you sharing your “tips and tricks” on SHANA forum.
 

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