Awake FOI with a glidescope?

[DreamLover]

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Anyone have any favorite recipes for topicalization for awake intubation with a glidescope? Ive never used a glidescope for an awake intubation and I don't want to have to sedate too much...but the glidescope sounds painful to me, even with lidocaine.....any opinions or ideas welcome

 

[Idiopathic]

ive done an awake look with 100mg of ketamine and the Mcgrath before, once i had the view i wanted i induced. i know thats not what you are looking for, but im not sure i could have topicalized enough to tolerate the blade, and the patient refused awake FOI

 

[Arch Guillotti]

Just do your normal recipe. If it's done right, they should tolerate it fine.

 

[BuddhaCanooda]

If the patient is awake then can tolerate an FOB much easier than any plastic piece. You have more of an advantage with the awake folks since they maintain their muscular tone and can inhale as you advance the scope. Why would you need anything WITH the FOB?

 

[urge]

ive done an awake look with 100mg of ketamine and the Mcgrath before,e FOI

How is that awake?

 

[Ketafol20]

ive done an awake look with 100mg of ketamine and the Mcgrath before, once i had the view i wanted i induced. i know thats not what you are looking for, but im not sure i could have topicalized enough to tolerate the blade, and the patient refused awake FOI

Isn't 100 mg of ketamine beyond the "awake" phase?

What did you induce with? Sux?

 

[Ketafol20]

How is that awake?

Damn you beat me!

 

[btbam]

They were awake on pink elephant planet.

 

[Idiopathic]

How is that awake?

point taken. i did a spontaneously breathing look...potato, potato 😀

 

[climbingak]

Ive done several awake glidescopes. Just as easy as an awake FO in my opinion. I tend to do blocks for my awakes. On the last one I did I soaked q tips in 4% and put them in the tonsilar beds and then did a transtracheal. The last two I have done have been for cervical issues in patients having shoulder surgery. Needed them well blocked so after the intubation I could put them in position of surgery and have them give a thumbs up that they had no issues.

I think the biggest sensation you have to talk them through is a sense of fullness in their mouth. Sedated with minor amounts of fentanyl only. Crux was prepping the surgeon to not put production pressure to avoid the choke and puke fest that comes with a rush job.

 

[jetproppilot]

They were awake on pink elephant planet.

 

[imfrankie]

They were awake on pink elephant planet.

Highlight film

 

[imfrankie]

Anyone have any favorite recipes for topicalization for awake intubation with a glidescope? Ive never used a glidescope for an awake intubation and I don't want to have to sedate too much...but the glidescope sounds painful to me, even with lidocaine.....any opinions or ideas welcome

You can get a lot of mileage with a quality gargling of viscous lidocaine

 

[Ketafol20]

You can get a lot of mileage with a quality gargling of viscous lidocaine

This and a transtracheal is all I do. I quit the lido nebs bc it takes too long and don't work as well. Most people I know still do the nebs.

 

[cleansocks]

took part in a transtracheal block on an old uncooperative neuro pt with transtracheal block and slowly titrating up remi until she relaxed her mouth enough to get the glidescope in

 

[MTGas2B]

As far as topicalization, my favorite device is a glass atomizer. Not the throwaway syringe mounted ones, but a nice metal one that hooks to an oxygen source, use a venturi effect to pull local from a glass reservoir, and has a rotating spray nozzle at the tip. It puts out a very small amount of local, and you can spray for a long time. The advantage is that you have much more control of what you topicalize. Versus blasting a large amount with the disposable kinds.

I aim it straight back, spray until the back of the throat is numb to touch, then turn the nozzle 90 degrees down and keep spraying while having the patient painting. I wish we had them where I worked now.

Maybe I should get my own.

Kind of like this one.
http://www.foremostequipment.com/index.cgi?item=FME-24411&q=Medical Supplies&s=CATEGORY

 

[sevoflurane]

As far as topicalization, my favorite device is a glass atomizer.

+1 You can get some nice fine mist with these guys.

I used to block the glossopharyngeal all the time. I find myself not doing that much any more.

One of the most important steps is a good discussion with your patient. This can't be emphesized enough.

I used to block superior laryngeal, glossopharyngeal and do a transtracheal block along with a sphenopalantine gnaglion block (especially for nasals). I don't do the glossopharyngeal and superior laryngeal anymore.

Large nasal trumpet covered in viscous lidocaine with progressive insertion toward the glottis is nice. Then, you can take an atomizer through the nasal trumpet and spray right on the cords. They'll be raspy in no time.

 

[diceksox]

Done a few. Like awake FOB: cooperation + dessication + topicalization