Fiberoptic intubation - NYSORA

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Fiberoptic intubation

Learning objectives

  • Describe the principles, indications, and contraindications of fiberoptic intubation
  • Perform fiberoptic intubation
  • Describe the possible complications of fiberoptic intubation

Background

  • Fiberoptic intubation can be performed in awake (with or without sedation) or anesthetized patients
  • Awake fiberoptic intubation is the gold standard for anticipated difficult airways
  • Based on the optical characteristics of very thin flexible glass fibers that are capable of transmitting light over their length
  • Insulation of these fibers by a glass layer with a different optical density facilitates transmission by the internal reflection of light
  • In combination with a light source and lenses on both ends of the fiberoptic bronchoscope, images can be transmitted from the tip of the scope to the eyepiece

Indications & contraindications

  • Indications
  • Contraindications
    • Absolute
      • Patient refusal or inability to cooperate
    • Relative
      • Lack of trained personnel
      • Risk of impending airway obstruction
      • Coagulopathy or bleeding in the airway
      • Allergy to local anesthetic
      • Base of skull fracture (for nasal route)

Technique

fiberoptic intubation, sedation, iv, ecg, pulse oximetry, noninvasive blood pressure, capnography, glycopyrronium, atropine, hyoscine, remifentanil, propofol, midazolam, fentanyl, opioid, dexmedetomidine, oxygen, nasal sponge, nasal cannulae, lidocaine, co-phenylcaine, phenylephrine, xylocaine, adrenaline, nebulizer, pharynx, oropharynx, trachea, larynx, cricothyroid

fiberoptic intubation, semi-recumben, fiberscope, endotracheal tube, epidural catheter, berman, breathesafe, oropharynx, epiglottis, glottis opening, tongue, jaw thrust, mucose, laryngeal inlet, subglottic space, trachea, carina, capnography, anesthesia, extubation

Complications

    • Oversedation
    • Respiratory depression
    • Airway obstruction
    • Apnea
    • Trauma
    • Bleeding
    • Laryngospasm
    • Vomiting
    • Local anesthetic allergy
    • Toxicity
    • Risk of aspiration due to loss of laryngeal reflexes

Suggested reading

  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
  • Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014;59(6):865-880.

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