The awake intubation is a technique used for patients where all 3 lifelines are likely to be challenging. It is often called "awake fibreoptic intubation," however, most modern bronchoscopes don't actually use fibreoptic components. Some are moving towards "awake tracheal intubation" or "awake bronchoscopic intubation." At Periop Concepts, we use the term "awake intubation."
🔺 The 5 steps for awake intubation are:
1️⃣ Set up for GA:
👉 Always prepare as you normally would for general anaesthetic. Our GA checklist in the Anaesthetic Assistant Handbook will guide you through this!
2️⃣ Sedation:
👉 The choice of sedative agent will be determined by the anaesthetist. Whatever works best in their hands is a safe option, however, there are some well-known factors that increase risk or provide undesirable conditions. Agents that provide ideal conditions include remifentanil, alfentanil and dexmedetomidine. As the number of agents used increases, so does the risk of oversedation.
3️⃣ Spray:
👉 There are many devices available to spray local anaesthetic into the airway. The most appropriate is the "DeVilbiss atomiser" because it produces droplet size that makes its way to the large airways and larynx. Lignocaine is the safest agent to use, and the literature suggests a concentration of between 3-4% is most appropriate.
4️⃣ Scope & Tube:
👉 The tube will depend on the patient and whether you're going oral or nasal. Always confirm with your anaesthetist that the tube is the correct type, size and that you have lubricated the inner lumen. A snug fitting bronchoscope is essential.
5️⃣ Secure & Sleep:
👉 Perhaps the most important step is to confirm correct tube position using end-tidal CO2, and then inflating the cuff and securing the tube and proceeding to anaesthetise the patient. The patient will need constant reassurance until they are unconscious.
📖 Check out the Complete Guide to Airway Management for Anaesthetic Nurses and our Live Series session on Advanced Airway Techniques for more information!
✅ Build knowledge
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References:
Madden, J., 2023, The Complete Guide to Airway Management for Anaesthetic Nurses. Periop Concepts, Hobart, Tasmania.
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