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