Anaes Vivas · Airway management

Data viva — the sedation agents and the safety metrics for the awake fibreoptic intubation

A data viva on the awake fibreoptic intubation sedation pharmacology. The principle that the patient must remain cooperative and breathing is the frame. Dexmedetomidine — the cooperative arousable sedation, the preserved respiratory drive, the lowest desaturation rate, the opioid-sparing analgesia; the trade-off is bradycardia and hypotension. Remifentanil — the excellent conditions and the powerful cough suppression, offset by nausea, rigidity, apnoea at the effective dose. Propofol — titratable and familiar but respiratory-depressant. Midazolam-fentanyl — traditional but the synergistic respiratory depression is the classical pitfall. Plus the supporting safety metrics: the lidocaine 9 mg per kg lean-body-weight maximum and the LAST risk, the end-tidal oxygen metric as a measure of the preoxygenation quality, and the two-point (visual plus capnographic) confirmation before induction.