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    Airway Preparation For AFOI

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    annegirl
    This document discusses airway preparation techniques for awake fibreoptic intubation. It outlines four principles for preparing the airway: ensuring no secretions, no blood, no reflexes, and adequate sedation. Specific techniques are described to achieve each of these goals, including medications to dry secretions, vasoconstrictors to minimize bleeding, topicalization and nerve blocks for anesthesia, and sedative medications. Both topical and nerve block techniques are discussed as options for airway anesthesia, with the best method chosen based on individual factors.

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    Airway Preparation For AFOI

    Uploaded by

    annegirl
    56 views48 pages
    This document discusses airway preparation techniques for awake fibreoptic intubation. It outlines four principles for preparing the airway: ensuring no secretions, no blood, no reflexes, and adequate sedation. Specific techniques are described to achieve each of these goals, including medications to dry secretions, vasoconstrictors to minimize bleeding, topicalization and nerve blocks for anesthesia, and sedative medications. Both topical and nerve block techniques are discussed as options for airway anesthesia, with the best method chosen based on individual factors.

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    Airway Preparation for AFOI

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    Airway Preparation for AFOI

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    This document discusses airway preparation techniques for awake fibreoptic intubation. It outlines four principles for preparing the airway: ensuring no secretions, no blood, no reflexes, and adequate sedation. Specific techniques are described to achieve each of these goals, including medications to dry secretions, vasoconstrictors to minimize bleeding, topicalization and nerve blocks for anesthesia, and sedative medications. Both topical and nerve block techniques are discussed as options for airway anesthesia, with the best method chosen based on individual factors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views48 pages

    Airway Preparation For AFOI

    Uploaded by

    annegirl
    This document discusses airway preparation techniques for awake fibreoptic intubation. It outlines four principles for preparing the airway: ensuring no secretions, no blood, no reflexes, and adequate sedation. Specific techniques are described to achieve each of these goals, including medications to dry secretions, vasoconstrictors to minimize bleeding, topicalization and nerve blocks for anesthesia, and sedative medications. Both topical and nerve block techniques are discussed as options for airway anesthesia, with the best method chosen based on individual factors.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    You are on page 1of 48

    Airway Preparation for

    Awake
    Fibreoptic Intubation

    Where will I need AFOI ??

    Decreased Upper Airway Open


    Space

    Distorted Airway
    Anatomy

    Fixed Tissues Of Upper


    Airway

    Limited Head Extension

    Limited Mandibular
    Subluxation

    Limited Mouth Opening

    Prepare for AFOI


    Explain the procedure to patient and
    obtain an Informed Consent

    Adequate Starvation

    Acid aspiration prophylaxis

    4 Principles For Preparing the


    Airway
    NO SECRETIONS
    NO BLOOD
    NO REFLEXES
    ADEQUATE

    SEDATION

    NO SECRETIONS
    IV

    IM

    Glycopyrrolate

    0.2 0.4 mg
    20 minutes
    before

    0.2 0.4 mg 30
    minutes before

    Atropine

    0.4 1 mg 20
    minutes
    before

    0.5 1 mg >
    30 minutes
    before

    NO BLOOD

    Oxymetazoline

    Dose For Topical


    Application
    0.05 % 2 sprays each
    nostril

    Phenylephrine

    0.5 % + lignocaine 2 4%

    Adrenaline

    1 : 200,000 + lignocaine 2
    4%

    NO REFLEXES

    NO REFLEXES
    TOPICAL

    NERVE BLOCKS
    B/L Glossopharyngeal N B
    B/L Superior Laryneal N B

    Lignocaine 4 % and
    10 %

    B/L Recurrent Laryngeal N


    B sensory
    For Nasal B/L Ant.
    Ethmoid N B + B/L Greater
    & Lessor Palatine N B

    TOPICALISATION OF
    AIRWAY

    Using Cotton Pledgets / Wool /


    Cotton tip applicators

    1. For nares
    2. Tonsillar pillars

    Topicalization of the oral mucosa

    10% LIGNOCAINE
    SPRAY
    1. Nostrils
    2. Post
    Pharyng
    eal Wall
    3. Post 1/3
    Tongue
    4. Tonsillar
    Pillars

    Atomizer

    30
    microns

    ATOMIZER
    30
    microns

    For
    1. Nasal
    2. Pharyngeal
    3. Palate
    4. Tonsillar pillars
    5. Post 1/3
    tongue

    Lignocaine

    Lollipop

    Lignocaine

    Lollipop

    For combined
    pharyngeal,
    periepiglottic
    and peri glottic
    anaesthesia

    Inhalation of Aerosolized Local


    Anesthetic

    Possible TOTAL
    AIRWAY ANAESTHESIA

    2%

    NERVE BLOCKS

    Nerve Blocks
    Anatomy of Nervous Supply
    CRUCIAL
    Never Exceed Toxic Dose Limits
    9mg/kg of Lidocaine
    Difficult to perform in obese patients
    and those with abnormal anatomy

    Glossopharyngeal nerve
    block

    Surface anatomy of the larynx


    for Superior laryngeal nerve block

    Superior laryngeal nerve


    block

    Trans Tracheal Block for


    RLN

    Best Method To Anaesthetize


    Airway??

    Topical vs Nerve Block??

    Adequate Sedation

    Adequate Sedation
    DRUG
    Dexmedetome
    dine
    Midazolam
    Fentanyl
    Remifentanyl
    Propofol
    Ketamine

    MOA
    Selective 1 agonist

    DOSE

    1mcg/kg over 10 min


    f/b 0.2 to 0.7
    mcg/kg/hr
    benzodiazep 0.05mg/kg
    ine
    opioid
    0.5 to 1.5 mcg/kg
    titrated to effect
    opioid
    0.75mcg/kg bolus f/b
    0.075mcg/kg/min
    i.v.
    Titrated no fixed
    anaesthetic dose
    i.v.
    0.3mg/kg

    Adequate Sedation

    BEST TECHNIQUE
    Tailored to
    a) Feasibilty of performance
    b) preference of
    anaesthetist and
    c) comfort of patient

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