Airway Preparation for Awake Fibreoptic Intubation
Airway Preparation for Awake Fibreoptic Intubation
Where will I need AFOI ??
Decreased Upper Airway Open Space
Distorted Airway Anatomy
Fixed Tissues Of Upper Airway
Limited Head Extension
Limited Mandibular Subluxation
Limited Mouth Opening
Prepare for AFOIExplain the procedure to patient and obtain an Informed Consent
Adequate Starvation
Acid aspiration prophylaxis
4 Principles For Preparing the AirwayNO SECRETIONS
NO BLOOD
NO REFLEXES
ADEQUATE SEDATION
NO SECRETIONSIVIMGlycopyrrolate 0.2 0.4 mg 20 minutes before0.2 0.4 mg 30 minutes beforeAtropine0.4 1 mg 20 minutes before0.5 1 mg > 30 minutes beforeNO BLOODDose For Topical ApplicationOxymetazoline0.05 % 2 sprays each nostril Phenylephrine0.5 % + lignocaine 2 - 4% Adrenaline1 : 200,000 + lignocaine 2 4%NO REFLEXES
NO REFLEXESTOPICALLignocaine 4 % and 10 %NERVE BLOCKSB/L Glossopharyngeal N B
B/L Superior Laryneal N B
B/L Recurrent Laryngeal N B sensory
For Nasal B/L Ant. Ethmoid N B + B/L Greater & Lessor Palatine N BTopicalisation of AirwayUsing Cotton Pledgets / Wool / Cotton tip applicatorsFor naresTonsillar pillars
Topicalization of the oral mucosa
10% LIGNOCAINE SPRAY
NostrilsPost Pharyngeal WallPost 1/3 TongueTonsillar PillarsAtomizer
30 micronsATOMIZER
For NasalPharyngealPalateTonsillar pillarsPost 1/3 tongue30 micronsLignocaine Lollipop
Lignocaine Lollipop
For combined pharyngeal, periepiglottic and peri glottic anaesthesia Inhalation of Aerosolized Local Anesthetic
Possible TOTAL AIRWAY ANAESTHESIA2% viscous
NERVE BLOCKSNerve BlocksAnatomy of Nervous Supply CRUCIAL
Never Exceed Toxic Dose Limits 9mg/kg of Lidocaine
Difficult to perform in obese patients and those with abnormal anatomyGlossopharyngeal nerve block
Surface anatomy of the larynx for Superior laryngeal nerve block
Superior laryngeal nerve block
Trans Tracheal Block for RLN
Best Method To Anaesthetize Airway??
Topical vs Nerve Block??
Adequate SedationAdequate Sedation DRUGM O ADOSEDexmedetomedineSelective -1 agonist1mcg/kg over 10 min f/b 0.2 to 0.7 mcg/kg/hrMidazolambenzodiazepine0.05mg/kgFentanyl opioid0.5 to 1.5 mcg/kg titrated to effectRemifentanylopioid0.75mcg/kg bolus f/b 0.075mcg/kg/minPropofoli.v. anaestheticTitrated no fixed doseKetaminei.v. anaesthetic0.3mg/kg
Adequate SedationBEST TECHNIQUE Tailored to
Feasibilty of performance
preference of anaesthetist and
comfort of patient