Time to abandon awake fibreoptic intubation?

The older generation of anaesthetists were taught direct laryngoscopy using the Macintosh blade, blind nasal intubation using red rubber tracheal tubes and, latterly, awake fibreoptic intubation in difficult airway situations. Today's generation of anaesthetists have a much broader selection of techniques at their disposal. Advances in regional anaesthetic techniques mean that they may choose not to administer a general anaesthetic at all; if they do choose a general anaesthetic, they may elect not to intubate the trachea, but rely on a supraglottic airway device (SAD) or they may intubate the trachea using the SAD as a conduit or they may intubate the trachea using newer equipment such as a videolarygoscope. However, awake fibreoptic intubation is still widely accepted as the gold standard in the management of the known difficult airway,

Anticipated Difficult Intubation: Should I Intubate The Patient Awake?

Many providers are uncomfortable with performing awake intubations and leave it as a last resort.

Intubation: Step By Step

In the event you can’t intubate easily, stop after 30 – 60 seconds. Ventilate the patient briefly before your next attempt in order to maintain oxygenation. As long as you can ventilate the patient you have time. Time to alter your technique, change the position of the head, or use a different type of laryngoscope blade. Keep your suction handy and use it. Don’t be afraid to ask for help.

C-Spine Intubation

It’s too difficult to intubate with a collar on. It must be carefully and temporarily removed. As Dr. Levine taught us, MILS impairs glottic visualization and first pass intubation success.

Awake Endotracheal Intubation

The biggest pitfall is not thinking about awake intubation early enough. Remember to consider awake intubation in any patient that is not acutely crashing. Failure to educate and prepare the patient adequately will often lead to an anxious, gagging patient and a failed attempt.

Awake Intubation

Can be performed using direct or video laryngoscopy or using a fiberoptic scope, and various methods of topicalisation/ local anaesthesia are described

Blind Digital Intubation

After the epiglottis is identified by palpating it with the long finger of the left hand, the bougie is threaded through the glottis and advanced into the trachea. Tracheal clicking elicits tactile vibrations, which confirm tracheal placement of the bougie.

How to Intubate the Critically Ill Like a Boss

Despite decades of experience with endotracheal intubation, we continue to find approaches to improving the process of how we intubate.

Intubation Blind Digital

After the epiglottis is identified by palpating it with the long finger of the left hand, the bougie is threaded through the glottis and advanced into the trachea. Tracheal clicking elicits tactile vibrations, which confirm tracheal placement of the bougie.

Intubation Positioning: Beyond Sniffing

Many providers are still trained almost entirely in ETI with a supine patient, but there is growing evidence that a head-up position can improve pre-oxygenation and facilitate ETI.

Intubation With Airway Bleeding and Massive Emesis

We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate?

Post-Intubation Sedation and Analgesia

The immediate post intubation period in the ED is a critical time for continued patient stabilization. While physical adjuncts like securing the tube, in line suctioning, and elevating the head of the bed are part of general post intubation management, better understanding of analgesics and sedatives have offered newer approaches.

The Difficult Airway: Common Errors During Intubation

Intubation in the ED often entails a chaotic environment, which requires a calm amid the storm in order to maintain sound judgment while making life-and-death decisions. A stepwise approach is needed to ensure no key steps were missed when deciding if a patient needs to be intubated, how the patient should be intubated, if it will be a difficult intubation, and how the difficult airway should be managed.

Tricks For Successful Intubation With The Glidescope

Regardless of which stylet you’re using, insert the endotracheal tube with the curve aimed toward the right side of the mouth, 3:00 o’clock position, under direct vision until you start to see it on the monitor.