Fiberoptic intubation - how often

[Laurel123]

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So, out of residency, how often are you guys doing fiberoptic intubations?

In over a year, none.

I am afraid my skills are getting rusty! Any tips?

 

[huktonfonix]

play XBOX! Or if youre bored in the OR, get a FBO make a little obstacle course out of whatevers handy and guide it through.

 

[deleted126335]

.

 

[Noyac]

Not very often.

I even did a C2 fx asleep the other day. I am very confident in my mask ventilation skills and my inline stabilization intubation. And if that doesn't work the friggin glidescope is the bomb (even if it is a crna tool). I don't like the pt coughing on an endotracheal tube with a broken neck. Even if you topicalize the airway they can cough so I lean towards the asleep method if they have a good enough airway.

 

[johankriek]

Not very often.

I even did a C2 fx asleep the other day. .

Not very cautious for medico-legal reasons. I wouldnt let myself out there like that... maybe in 7 years I will though..


I do more fiberoptics than anyone i practice with.. If there is any question.. I do awake fiberoptic on... because I enjoy doing them... and I dont see any draw back to them whatsoever....the eschmanss stylet and
laryngeal tube airway)similar to LMA.. are invaluable tools.. I would much rather have an eschmanns stylet than a glidescope..

 

[blackjack]

Who does nasal vs oral foi's? Nasal here.

 

[Noyac]

Not very cautious for medico-legal reasons. I wouldnt let myself out there like that... maybe in 7 years I will though..

We monitor EMG's throughout. If any problem you wake the pt up and test motors. I have been doing this for quite some time now and no complications. I like my approach. I don't recomend it for everyone but it works very well for me.

 

[Noyac]

Who does nasal vs oral foi's? Nasal here.

Both, I don't really care which way it goes.

 

[blackjack]

Both, I don't really care which way it goes.

So how do you decide which approach?

 

[Laurel123]

Not very cautious for medico-legal reasons. I wouldnt let myself out there like that... maybe in 7 years I will though..


I do more fiberoptics than anyone i practice with.. If there is any question.. I do awake fiberoptic on... because I enjoy doing them... and I dont see any draw back to them whatsoever....the eschmanss stylet and
laryngeal tube airway)similar to LMA.. are invaluable tools.. I would much rather have an eschmanns stylet than a glidescope..

Actually that is an interesting debate that I remember thinking through in residency. The C2 fracture patient. On the one hand, if you do an awake FOI you can get the tube in and then make sure all limbs are moving and medicolegally you are cleared. However, even with awesome topicalization, the patient will cough. Sometimes during the transtracheal or during topicalization or during placement of the tube through the cords. So in that sense, it could be safer to have the patient asleep and relaxed before instrumenting the airway.

 

[Planktonmd]

So how do you decide which approach?

My approach is: oral, unless there is an indication for nasal intubation or a contraindication for oral intubation.

 

[InductionAgent]

Tip to keep sharp- Start doing them on cases that you don't NEED to do them to keep your skills up.

What do you tell your patients who don't need fiberoptic that you're planning to practice on? Do you at least select Mallampati 3s, so that you can honestly say something like "you have a large tongue, which could create difficulty in establishing an airway..."

 

[Noyac]

What do you tell your patients who don't need fiberoptic that you're planning to practice on? Do you at least select Mallampati 3s, so that you can honestly say something like "you have a large tongue, which could create difficulty in establishing an airway..."

I think he means practicing while the pt is asleep w/c would be fine since you are going to intubate anyway and FOI is an accepted way of intubating someone. I don't see a problem or a reason for further consent. Its not like you are practicing something that could hurt the pt.

 

[deleted126335]

.

 

[InductionAgent]

Thanks for the feedback, Dr. Doze and Noyac. Doing some asleep fiberoptics on some patients with less challenging airways sounds like a reasonable proposition to suggest to attendings so I can get more practice.