Fibreoptic Intubation
Last modified: 14 September 2023, 11:07:34 AM AEST
Gems1 / 5
- only useful for supraglottic obstruction
- glottic / subglottic obstruction will need other solutions
- eg. tracheostomy
- orientation
- use trachealis muscle as guide for posterior wall of trachea
- FOI is like a controllable bougie
- great for double setup with video laryngoscope
- FOI has 3 key elements, as with all AW procedures
- Oxygenation = prevent hypoxia, maximise time for procedure
- Topicalisation = LA technique
- Anaesthesia = degree of sedation
- Technique = using the FOB
Equipment2 / 5
- Karl Storz Video Scope 5.5 mm x 65 mm scope
- Fastrach ETT 7 mm ID
- load FOB with ETT and epidural catheter
Position3 / 5
- stand in front of the patient
- this is because this is where you will stand for a patient in extremis
- ie. they will be sitting upright, in the tripod position, and you will not be able to stand behind and intubate
- this is because this is where you will stand for a patient in extremis
Topicalisation4 / 5
- epidural catheter
- feed through FOB
- use IN port of FOB
- 15 L/min FGF + syringe through port (attach using 3-way tap)
Technique5 / 5
-
HFNP + spray through nostrils (atomises down nasopharynx to glottis)
-
Grab tongue with gauze
-
Advance FOB to above cords
-
spray with epidural catheter
-
advance epidural catheter through cords + spray again
-
Intubate trachea with FOB
-
check depth of carina
-
ETT 2-3 cm above carina
-
Technique
- Keep it simple
- Unless there are CIN, nasal AFOI
- Test that ETT fits over FOB
- NPA + LA gel > then size up with a NPA cut with longitudinal slit
- Advance FOB
- Spray cords and WAIT for 1 minute
- Intubate and go to carina so it doesn't flick out