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Updated: May 28, 2026

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation
Published on: August 2, 2024
Focused Nebulization for Awake Fibreoptic Nasotracheal Intubation in a Severely Distorted Upper Airway: A Case Report
Kausika Sundaram1, Devalina Goswami, Tapeshwar Kumar
1From the Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Abstract:
Awake flexible bronchoscopic (FB) nasotracheal intubation is recommended for anticipated difficult airways, but its success depends on effective airway topicalization. We report a case of a patient with a severely distorted upper airway due to a maxillary tumor, where conventional topicalization techniques were impractical. Directed nasal nebulization of lidocaine using an uncuffed endotracheal tube (ETT) as a conduit, supplemented with spray-as-you-go (SAYGO) anesthesia and dexmedetomidine sedation, facilitated successful awake intubation. This case demonstrates the applicability of directed nasal nebulization in complex airway anatomy when alternative topicalization strategies are limited.
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