Awake Fiberoptic Concoctions

[DrRobert]

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Anyone care to list their favorite recipe for awake fiberoptic intubations?

I haven't done enough to have a favorite, but these are the most common regimens I've seen so far.

Airway:
1. Cetacaine spray
2. Transtracheal lidocaine
3. Lidocaine nebulizer

Sedation:
1. Versed + Fentanyl
2. Versed + Precedex + Fentanyl
3. Precedex + Fentanyl
4. Versed + Ketamine
5. Precedex + Ketamine
6. Versed + Precedex + Ketamine

I've even seen small boluses of propofol added to the above.

 

[Planktonmd]

In chronological order:
1- Lido 4% Nebulizer.
2- Glycopyrrolate.
3- Midazolam.
4- Remifentanyl drip.
5- Transtracheal block.
6- Sometimes lidocaine atomizer especially if the transtracheal is not practical or not possible.

 

[Noyac]

Viscous Lido swish for 1 min and swallow.
Transtracheal inj.
Versed sedation or Precedex if necessary.
Afrin nasal spray

 

[VentdependenT]

4% atomized lido till loss of gag.

1-2mg versed, 50ucg Fentanyl.

Cover eyes (patient's, not yours).

Look down with scope.

4cc 4% lido through workport onto cords. Let patient cough.

Go back in with scope and put in da ett.

 

[seinfeld]

1. glyco, wait until patient has dry mouth
2. neb 4% lidocaine
2b. if without complete block, touch up with atomizer of 4% lido
3. low dose remifent infusion
4. scope and tube

 

[Queuebee]

A little ketamine, a little versed, a little fentanyl
1. Recurrent laryngeal n. block w/ 2% lido
2. Glossopharyngeal n. block 2/ 2% lido
3. Transtracheal block w/ 4% lido
Sometimes a lidocaine neb beforehand.

 

[Planktonmd]

1. Recurrent laryngeal n. block w/ 2% lido
.

Did you mean superior laryngeal nerve block?

 

[Queuebee]

oops, yeah.

 

[johankriek]

4% atomized lido till loss of gag.

1-2mg versed, 50ucg Fentanyl.

Cover eyes (patient's, not yours).

Look down with scope.

4cc 4% lido through workport onto cords. Let patient cough.

Go back in with scope and put in da ett.

nice
the above obviates the need to do transtracheal.. underscores the importance of the 4 percent lidocaine below the cords.. However, I dont do this because i do transtracheal with 4 percent lido. But im always worried about putting a needle throught the airway. but nice technique

 

[Noyac]

nice
the above obviates the need to do transtracheal.. underscores the importance of the 4 percent lidocaine below the cords.. However, I dont do this because i do transtracheal with 4 percent lido. But im always worried about putting a needle throught the airway. but nice technique

The nice thing about the transtracheal is that if something should go wrong you know right where to go for jet ventilation. I have done a transtracheal b/4 and left the angio in place just for this reason.

 

[sevoflurane]

Glyco
Peace pipe
Glossopharyngeal
Superior Laryngeal
Transtracheal
Shenopalentine block- cotton tip applicators with "special ester" to middle and posterior turbinates.
+/- remi +/- dex
Afrin

 

[VentdependenT]

Glyco
Peace pipe
Glossopharyngeal
Superior Laryngeal
Transtracheal
Shenopalentine block- cotton tip applicators with "special ester" to middle and posterior turbinates.
+/- remi +/- dex
Afrin

I've done it with just the peace pipe (4% NEBULIZED Lido) and that was it.