FOB / Topicalisation
Last modified: 14 September 2023, 10:53:32 AM AEST
Gems1 / 5
- Lignocaine 10% = 100 mg/mL
- 1 spray = 100 micromL = 10 mg
- Allows "sprays/kg"
- Lignocaine max = 7 mg/kg
- 70 kg = at 10 mg/kg is 700 mg = 70 sprays of 10%
- Max dose
- Serum concentration 5 mcg/mL
- 15.4 mg/kg may be used without serious adverse effects but subjective symptoms of lidocaine toxicity were reported in studies using 9.6 mg/kg (Level 2+ evidence, BTS 2013)
- Effective cough suppression achievable with low total doses ~ 160 mg
- Traditional limits
- Lidocaine with adrenaline = 7 mg/kg
- Lidocaine without = 4.5-5 mg/kg
- Drixine
- Oxymetazoline
- Can use this = separate LA from vasoC
- Coughing means the LA has reached the cords / trachea
- Definitive endotracheal = carina, not ETCO2 (could be from mouth)
Technique / description2 / 5
- Glycopyrrolate
- Dessication
- Essential for LA to be absorbed by mucous membranes
- IM is slower and lasts longer
- Glycopyrrolate 400 mcg IM
- Other adjuncts
- Morphine 10 mg IM
- Metoprolol PO
- Must have a system that works without a IVC
- Cophenylcaine spray to nostrils
- Cophenylcaine cotton bud / ribbon gauze
- Go below the inferior turbinates
- Lignocaine 2% gel to nasopharynx
- This is the same as for IDC insertion
- Lignocaine 10%
- Leave until LAST = it will wear off!
- Spray nasally
- Then spray orally
- Epidural catheter
- 18 G Touhy
- 2% Lignocaine + Adrenaline 1:200,000
- Atomiser
- 14 G IVC
- 3 way tap
Through the bronchoscope3 / 5
- O2 tubing + gravity giving set + chooks foot
- This provides oxygenation, provides excellent LA dispersion, and helps clear secretions also
- This can be attached to the top of the Ambu also using the supplied connector
- Syringes direct via connector to top of Ambu
- Less effective = no airflow, but adequate for vocal cords
- Epidural catheter
- Can be less effective, limited by location of holes
LA Syringes4 / 5
- 1 mL syringes x 10 with 1% lignocaine with Ad
- 10 mL syringes with 2-3 mL in each with air