Anaes SAQs · Airway management

The anticipated difficult airway and the awake fibreoptic intubation

A second-part SAQ on the awake fibreoptic intubation (AFOI). The indications (the predicted difficult airway, the aspiration risk where RSI is also unsafe, the critically ill patient who cannot tolerate apnoea); the six-step technique (prepare, topicalise, sedate, insert scope, railroad tube, confirm then induce); the topicalisation (lidocaine gel, 10 per cent spray, spray-as-you-go spray-as-you-go, the 9 mg per kg lean-body-weight maximum, the LAST risk); the sedation (single-agent dexmedetomidine or remifentanil appropriate, propofol alone the greater over-sedation risk); the principle that the patient must remain cooperative and breathing; the alternatives (awake video laryngoscopy, intubating LMA, retrograde) and the contraindications.