How to topicalise the airway for awake fibreoptic intubation (AFOI)
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- Опубликовано: 2 окт 2024
- Demonstration of a simple, rapid, safe and effective method of topicalising the airway for awake fibreoptic intubation with readily available equipment.
Equipment:
Teleflex MADgic™ malleable topical anaesthetic drug delivery device (or similar)
Oxygen tubing
2-way or 3-way catheter
Oxygen delivery device (cylinder or anaesthesia machine)
Local anaesthetic
why they are using intubation while the patient awake !is there any fractures
Awake intubation is much more common than you'd think (I was shocked as well when i first learned this). It typically requires fiberoptics, so it may not be common in some areas or in facilities that have chosen not to use fiberoptics. One of my professors uses it weekly, sometimes multiple times a week in his practice. It's a great option for patients who would have any sort of airway compromise while sedated, and/or for patients who you'd think could not be adequately mask-ventilated once sedated +/- muscle relaxed. Some of the difficult airway algorithms encourage the consideration of awake fiberoptic intubation as a plan A.
The option of obtaining a secure airway with minimal discomfort to the patient and without having to deal with the potential cardiovascular adverse effects of the anesthetic induction and without causing apnea is great. This adds so many layers of safety that the question should be why not to use it as a standard procedure.
Hi there, great video. May i ask if the 3 way connector that was used is one with a one way valve feature? Have tried adapting using just a 3 way tap- doesn't seem to work as well!
Easy, minimal faffing around. Single device to topicalise. Nice technique. Sure as hell beats nerve blocks, trans-tracheal injection, viscous lignocaine on tongue depressors, or pledgets soaked in local for nose!
How much ml of 4 % lignocaine was given through atomizer ?
This is a very useful and easy to digest video- thanks!
Really helpful! Thank you!
Well done Ed and the Royal Free team! Very informative video. I'll definitely use this technique in the future.
One limitation, however, is getting the atomiser inside the mouth of a patient with severe trismus. Solutions??? Spray as you go? Nebulised local anaesthetic?
Would be great to see some more content from you guys!
Using this technique in the nose will reliably topicalise the airway down to the carina, provided that injections are timed with the patient's deep inspirations through their nose. You don't need much mouth opening to get the MADgic into the mouth.
very interesting and educational would love to see more videos
Love this from Venezuela!