FIBRE OPTIC INTUBATION (AWAKE INTUBATION).pptx
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This document discusses fibre optic intubation, also known as awake intubation. It begins by outlining the history and indications for awake intubation. These include situations where mask ventilation may be difficult or pose an aspiration risk, such as limited mouth opening or cervical spine issues. It then describes the common nasal and oral techniques used, including patient preparation with nerve blocks, lidocaine, and sedation options. Various sedation drugs and their advantages are compared. Other alternative intubation techniques that can be used awake are also mentioned.
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2. Several physical exam findings can predict difficult airways, including reduced neck mobility, short chin-to-hyoid or thyromental distances, large tongue size, and reduced mouth opening.
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2) There are different modes of fiberoptic intubation including anesthetized oral, anesthetized nasal, awake oral, and awake nasal. Proper airway anesthesia and sedation techniques are important to prepare for awake fiberoptic intubation.
3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
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1. Tracheal extubation requires careful planning and preparation to prevent complications like laryngospasm, laryngeal edema, and pulmonary aspiration.
2. Patients should generally be extubated awake to allow for airway protection, but deep extubation may be considered to reduce cardiovascular stimulation.
3. Potential problems include mechanical issues removing the tube, cardiovascular changes, respiratory complications, and airway obstruction. Management depends on the specific issue but may include medications, positioning, or alternative extubation techniques.
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sellick maneuver, BURP , OELM
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2. Several physical exam findings can predict difficult airways, including reduced neck mobility, short chin-to-hyoid or thyromental distances, large tongue size, and reduced mouth opening.
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3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
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This document discusses the anatomy and physiology of the airway and provides guidance on proper airway management techniques. It describes the structures of the airway from the nose to the trachea. It emphasizes the importance of evaluating each patient's airway, having the proper equipment, and developing adequate skills to successfully manage the airway. Techniques covered include use of oral and nasal airways, laryngoscopy, endotracheal intubation, and developing a backup plan for difficult airways.
Advanced Airway Management
This document provides information on various advanced airway management techniques including orotracheal intubation, nasogastric tubes, suctioning, and use of alternative airways like Combitubes. It describes how to perform each technique, important anatomy, sizes of equipment to use, potential complications, and considerations for intubating infants and children due to anatomical and physiological differences from adults.
Airway anatomy
This document discusses the anatomy and anesthetic implications of the upper airway, including the nose, oral cavity, pharynx, and larynx. Key points include the vascular and sensitive nature of the nasal mucosa which can lead to bleeding, the importance of tongue position and mandible placement in maintaining an open airway, and how the collapsible soft tissues of the oropharynx make it particularly prone to obstruction. Proper understanding of upper airway anatomy is essential for airway management during anesthesia.
Airway management
This document discusses various airway management techniques. It covers opening airway maneuvers like head tilt, chin lift, and jaw thrust. It also discusses airway adjuncts like oropharyngeal and nasopharyngeal airways. Oropharyngeal airways are curved plastic tubes inserted into the mouth to maintain a patent airway. Nasopharyngeal airways are soft tubes inserted into the nose. The document details insertion techniques and complications for both. It also covers advanced airways like laryngeal mask airways and endotracheal tubes, their indications, and potential complications. Finally, it lists different oxygen delivery systems like nasal prongs, face masks, and high flow masks.
Airway management final
This document provides an overview of airway management. It reviews airway anatomy, including the upper airway (pharynx, larynx) and lower airway (trachea, bronchi). Basic airway maneuvers like head-tilt/chin-lift are described. Blind insertion airways like the oropharyngeal airway, nasopharyngeal airway, LMA, and Combitube are then reviewed. Endotracheal intubation procedure is outlined, including indications, equipment, positioning, placement verification, and post-intubation management. Surgical airways of cricothyroidotomy and tracheostomy are indicated in cases of failed intubation due to airway obstruction or anatomy distortion
Managing the Difficult Airway
The document discusses the assessment and management of difficult airways. It begins with an introduction and overview of relevant anatomy. Assessment techniques are described, including patient history, physical exam findings like Mallampati score, and imaging. Management strategies for anticipated difficult intubation are outlined, such as specialized equipment, alternate airway devices, and surgical airway options if needed. Complications are noted and the importance of documentation and follow-up emphasized.
Approach to resp distress
1) The document discusses respiratory physiology and assessment in pediatric patients. Respiratory rate varies by age, from 30-60 breaths/min in infants to 12-16 breaths/min in adolescents.
2) Features of respiratory distress include tachypnea, nasal flaring, chest wall retractions, and added sounds like stridor, wheezing or grunting. Assessment involves evaluating airway patency, breathing, and circulation.
3) Immediate care focuses on ensuring an open airway, providing oxygen, and supporting circulation. Further management depends on specific conditions and may include needle thoracotomy for suspected pneumothorax.
airway assesement.pptx
This document discusses airway assessment and management for an unconscious patient. It outlines maneuvers like head tilt-chin lift and jaw thrust to open the airway. Oropharyngeal and nasopharyngeal airways can help maintain a clear airway. Proper sizing and positioning of airways is important. Goals of emergency airway management are to ensure a patent airway, oxygenation, ventilation, and prevent aspiration.
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FIBRE OPTIC INTUBATION (AWAKE INTUBATION).pptx
- 1. FIBRE OPTIC INTUBATION (AWAKE INTUBATION) BY : SN HAINIS ARTIKAH BINTI ZAHINOR
- 2. Outline Indications Approaches Patient preparation Nasal Oral Nerve blocks Sedation Other approaches
- 3. History Peter Murphy, in England, in 1965 used a fiberoptic choledocosope to intubate nasally a pt with Still’s disease.
- 4. Indications for Awake Intubation Need for intubation where ability to ventilate via mask or supraglottic airway is unlikely or poses an aspiration risk History of need for awake intubation Anatomic features that are worrisome Limited mouth opening, reduced neck mobility, cervical spine instability, anatomic malformations of mandible or larynx, congenital deformities (Pierre Robin), head and neck cancers, trauma to the face, airway.
- 5. How common are difficult airways Review of 50,000 records excluded planned fiberoptics Found impossible to mask was only 0.15%, and 25% of those were difficult to intubate
- 6. Neck movement When compared with DL or glidescope FOI causes less movement of cervical spine
- 7. Techniques: Nasal Preferred when: large tongue, limited mouth opening receding lower jaw, or tracheal deviation or in cases in which an unobstructed surgical field is beneficial (eg, dental surgery). This approach is also anatomically favorable in that the laryngeal opening is more easily seen with the fiberscope as it courses past the nasopharynx with less obstruction by the tongue
- 8. Nasal Anti-sialogogue: Glycopyrollate 0.1-0.2mg Afrin or phenylephrine and lidocaine to nare, ask which is more open Inhaled nebulized lidocaine at 5l/min flow for correct droplet size, not trying to get into lungs, have pt stick out tongue Spray additional high concentration lidocaine through atomizer into back of throat and directed down on cords 5% lidocaine ointment onto tongue depressors with 4x4 attached, paint back of throat and let drip down while pt bites on tongue blade Plus/minus trans-tracheal injection of lidocaine, more concentrated is better Can also “spray as you go”
- 9. Nasal continued Dilate nare with increasing size of lubed NP airways Insert tube with gentle pressure until passes into oropharynx, then inflate balloon and draw back until resistance is felt Insert fiber and pass into cords, deflate cuff and advance tube Ideally use smaller tube, 6-5 or 7-0 better than 7-5 or 8-0 due to ease of passage into trachea If you cannot visualize cords, try having someone do a jaw thrust and/or pull the tongue out of the mouth with a 4x4 If scope is in trachea but tube won’t pass, withdraw slightly and rotate 90 degrees and try again, then another 90 degrees. If necessary try corkscrew Parker Flex tip tube has curved tapered distal tip to slide past cords more easily
- 10. Oral Harder due to tongue, more anterior path needed to get to cords No nasal prep needed, otherwise the same Can use special oral airway such as Ovassapian with central channel to pass scope Jaw thrusts and tongue out can really help here Key is staying midline, walk along the tongue, manipulate ETT
- 11. Nerve Blocks Glossopharyngeal nerve supplies sensory to posterior third of tongue, vallecular, anterior epiglottis, walls of pharynx, tonsils Block by holding pledgets with lidocaine at tonsillar pillars or injecting at mandible and mastoid processes. Superior laryngeal nerve provides sensory to base of tongue and posterior surface of epiglottis to arytenoids. Block by injecting local at cornua of hyoid bone Vagus nerve branches (recurrent laryngeal) supply sensory innervation to the underside of epiglottis and trachea Transtracheal block 1% lido can last 75 minutes, up to 400 minutes with 1:200,000 epi
- 12. Sedation Depends on how scary the airway is, okay to use no sedation Versed +/- fentanyl Remi bolus vs drip (0.5-1mcg/kg and 0.05-0.1 mcg/kg/min) Ketamine bolus vs drip (0.3-0.5mg/kg and 10mcg/kg/min) Precedex, load and drip (0.4-1mcg/kg bolus over 10 min + 0.5- 1mcg/kg/HR) General anesthesia with spontaneous ventilation, inhaled or propofol More hypoxia with propofol Remi vs. Prop: Remi better conditions, better tolerated, patients breathed when told to Precedex vs prop: Precedex superior in terms of hemodynamic stability and not having airway obstruction Precedex vs remi: Precedex better in terms of desaturations Johnston KD and Rai MR Consious Sedation for awake fiberoptic intubation: a review of the literature. Can J Anesth (2013) 60:584-599.
- 13. Other techniques Fiber through LMA Awake glidescope Awake DL DL and fiber or glidescope and fiber