Awake intubation: Difference between revisions
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==May use any of the following techniques:== | |||
* Fiberoptics (most common) | * Fiberoptics (most common) | ||
* Direct Laryngoscopy | * Direct Laryngoscopy | ||
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* Tracheostomy | * Tracheostomy | ||
==Indications== | |||
When masked ventilation or intubation is suspected to be difficult, such as those with complicated anatomy or cannot tolerate supine positioning | When masked ventilation or intubation is suspected to be difficult, such as those with complicated anatomy or cannot tolerate supine positioning | ||
==Contraindications== | |||
Patient compliance or refusal | Patient compliance or refusal | ||
==Drugs== | |||
It is important to maintain spontaneous breathing | It is important to maintain spontaneous breathing | ||
* Local anesthetics (i.e. lidocaine) | * Local anesthetics (i.e. lidocaine) | ||
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** '''Remifentanil''' - rapid offset of action | ** '''Remifentanil''' - rapid offset of action | ||
==Example of Technique<ref> Awake Intubation. British Journal of Anaesthesia https://academic.oup.com/bjaed/article/15/2/64/248570</ref>== | |||
* Preoxygenate the patient | * Preoxygenate the patient | ||
* Position the patient | * Position the patient | ||
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* Sedation/analgesia for patient | * Sedation/analgesia for patient | ||
==See Also== | |||
*[[Intubation]] | |||
==References== | ==References== | ||
Revision as of 13:20, 27 February 2018
May use any of the following techniques:
- Fiberoptics (most common)
- Direct Laryngoscopy
- Video Laryngoscopy
- Blind Nasal Intubation
- Tracheostomy
Indications
When masked ventilation or intubation is suspected to be difficult, such as those with complicated anatomy or cannot tolerate supine positioning
Contraindications
Patient compliance or refusal
Drugs
It is important to maintain spontaneous breathing
- Local anesthetics (i.e. lidocaine)
- Sedation - must be mild to avoid respiratory depression or apnea. Sedation is frequently required for patient tolerance
- Midazolam - used in small boluses, but has no analgesic properties (may use fentanyl in addition)
- Propofol - challenging to balance sedation
- Dexmedetomidine
- Remifentanil - rapid offset of action
Example of Technique[1]
- Preoxygenate the patient
- Position the patient
- Switch oxygenation from face mask to nasal cannula
- Topical anesthesia
- May be done via transtracheal route, allowing for possible Seldinger cricothyroidotomy, if necessary as a back-up.
- Light Sedation
- Visualization of anatomy
- Intubate
- Confirm Placement
- Secure Endotracheal Tube
- Sedation/analgesia for patient
See Also
References
- ↑ Awake Intubation. British Journal of Anaesthesia https://academic.oup.com/bjaed/article/15/2/64/248570