[Fiberoptic intubation of neurosurgical patients]

Patients with cervical spine injury presenting with respiratory distress require airway management that does not compromise integrity of the atlanto-occipital joint. Endotracheal intubation by means of direct laryngoscopy is not suitable. The method of choice is nasotracheal intubation of the awake patient, using a flexible fibre bronchoscope. If anatomy or surgical access render the nasal approach impossible, fibre optic intubation can be performed orotracheally, utilising specific technical aids. Flexible fibrescopes are available in different sizes (length and diameter): selection is base on the patient's anatomical requirements. Aids to orotracheal intubation are constructed with a bore wide enough to accommodate an endotracheal tube, and a face mask equipped with an extra intubation port allowing introduction of an endotracheal tube, slipped over a fibrescope. Premedication of the patients consists of an orally administered benzodiazepine. Topical anaesthesia and vasoconstriction of the nasal passages are achieved by cocaine (5-10%), or a local anaesthetic, combined with a vasoconstrictor. The selected nostril is prepared by means of introducing a nasopharyngeal airway, which--lubricated with xylocaine gel and left in place for few minutes--widens the nostril and facilitates passage of the endotracheal tube. Through the other nostril, oxygen is administered. Systemic analgo-sedation is strictly limited to fentanyl, 0.1 mg i.v. Topical anaesthesia of the larynx and cranial trachea is achieved by xylocaine, 2%, administered under direct vision through the instrumentation channel of the fibrescope.(ABSTRACT TRUNCATED AT 250 WORDS)