This instructional video demonstrates awake nasal fiberoptic intubation, a technique used in cases of upper airway obstruction where standard transoral intubation is not safe. Designed for operating room staff, the presentation covers equipment setup, patient preparation, and step-by-step guidance to ensure a secure airway while maintaining patient safety and comfort
Awake nasal fiber optic intubation is a safe method for intubating a patient who cannot be intubated transorally in certain diseases. These diseases include advanced head and neck cancers, severe angioedema, or epiglottitis. Awake nasal fiber optic intubations are used in difficult airway scenarios. Difficult airways are best managed with a multidisciplinary approach. However, many operating room staff feel uncomfortable with this uncommon procedure. This video will cover how to safely set up and the basics of performing an awake nasal fiber optic intubation. To perform an awake nasal fiber optic intubation, you will need the following items. A bronchoscopy tower. A bronchoscope. A and spray. This is lidocaine. A 24 to 34 inch nasal trumpet. 4% lidocaine. A slip tip syringe. Filled with 4% lidocaine. C can spray. Warm saline. A 6.5 endotracheal tube. Needle drivers. Connected to the adapter for the 6.5 endotracheal tube. An empty 10 mL syringe to blow up the cuff balloon. And towel clamps. First, before performing awake nasal fiber optic intubation, the patient's nose is prepared for the procedure. This begins with anesthetizing and decongesting the nose with Afrin spray. Next, viscous lidocaine is applied liberally through the nose with the side you plan to intubate. It Next, the nasal trumpet from 28 to 34 French is placed through the nose. After the nasal trumpet is placed, a nebulizer of 4% lidocaine is applied for approximately 10 minutes. In addition to the bronchoscope and awake nasal intubation supplies, it's always important to have a backup airway plan and supplies prepared in the room. The most important supplies to have are a tracheostomy tray and or a cricothyrotomy kit. As well as a cuffed tracheostomy too. Other supplies that are helpful to have include Adida laryngoscope or other exposing longoscope, a light source for the lorengoscope. A tooth guard. Anti-fog. A light box for the Laoscope. Telescope and an endotracheal tube can be placed over the top of. After the nose has been prepared and anesthetized, the operating room is prepared for intubation. The operating room table is positioned in the beach chair position as shown here. Sheets and towel clamps are going to be used to the patient. The table is covered with extra sheets, as well as safety straps. Next, the patient is placed in the operating room, on the operating room table in the beach chair position. Oxygen is given to the patient by a nasal cannula. This is applied to the mouth since the nose is still being prepared and dilated. Additional monitors, such as cardiac leads are applied to the patient before proposing. After all the monitors are in place, it's important to check that we have at least one functional IV typically in a hand. When we're ready, we'll next proceed with the pussi. The draw sheets will be drawn up around the patient. It's important to cover the majority of the patient's upper body with these. The draw sheets are then secured with towel claims. Next, safety straps are applied. Yeah Once the patient is refused, it's important to confirm that you still have good IV access in one hand. And that the patient cannot easily move out of the papu. With the patient papoose, it's also important to check that we have a bogie pad in place in the event of a failed awake nasal intubation and you need to convert to a tracheostomy. The bobby pad is placed on one of the patient's legs. And hung off the side of the bed. With the patient profused and prepared in the operating room, the last step before intubation is lubricating the bronchoscope and the endotracheal tube with cedecane spray. Cdecane spray is sprayed through the endotracheal tube. As well as on the outside of the tube. It is also sprayed over the bronchoscope. Now that the patient has been proposed and prepared and all the equipment is set up, it's time to proceed with the intubation. The cedocaine spray and bronchoscope will be placed through the endotracheal tube. Next, the bronchoscope will be inserted through the side of the nose that was dilated. The nasal trumpet is removed for this step. It is no longer coughing significantly. On deep inspiration, the bronchoscope is quickly advanced through the vocal cords. The endotracheal tube is then quickly advanced over the bronchoscope. And into the airway. Once it's confirmed with visualization, that the tip of the bronchoscope or the tip of the endotracheal tube is in the airway above the carina. The bronchoscope is slowly advanced out while the tube is held in place by an assistant. The endotracheal tube adapter is then placed, the cup is inflated, and the anesthesia circuit is connected to ensure al carbon dioxide is present. Onceital carbon dioxide is confirmed, anesthesia medications are then pushed. Awake nasal fiber optic intubation is a technique to safely secure certain difficult airways. Proper patient preparation and equipment set up are essential to safely and efficiently performing this procedure. A 2 provider approach where one individual inserts the bronchoscope and one pushes the endotracheal tube, is best to safely perform this procedure. We hope that this video has provided additional information to make you more comfortable with the setup and basics of performing awake nasal fiber optic intubation.
BROADCASTMED