Fibreoptic intubation in awake patients

Area of Science:

• Anesthesiology
• Airway Management

Background:

• Awake fiberoptic intubation is recommended for adult patients with predicted difficult airways.
• This technique mitigates the risk of the
• cannot ventilate, cannot intubate" scenario during anesthesia induction.

Observation:

• Three male patients with Mallampati scores 2-3 underwent elective surgery.
• Premedication included midazolam and atropine, with topical lidocaine for airway anesthesia.
• Intravenous midazolam and fentanyl were administered prior to fiberoptic bronchoscope insertion.

Findings:

• A reinforced endotracheal tube was successfully inserted using a fiberoptic bronchoscope.
• Oxygen and lidocaine were administered via the scope's working channel.
• The described method proved safe and effective for managing predicted difficult airways.

Implications:

• This awake intubation strategy is recommended when airway patency is uncertain during anesthesia induction.
• It is particularly useful in cases of previous failed intubation attempts.
• The technique is generally well-tolerated by motivated patients and rarely causes desaturation.