FIBEROPTIC
INTUBATION
Dr.Hussein Abdul - adheem
Objectives
• Introduction
• Airway Anatomy
• Indications
• Contraindications
• Preparations
• Technique
• Complications
• Resources
Introduction
• The term fiberoptic intubation refers to a technique of establishing
endotracheal intubation using the assistance of a fiberoptic device capable of
bending light and providing a view of the patient’s glottic aperture.
• This includes handheld flexible bronchoscopes as well as video laryngoscope
technology.
• The key to successful airway management using a fiberoptic technique
depends upon several factors.
• These include extensive knowledge of airway anatomy, adequate local
anesthesia in the airway (if awake), a thorough preoperative airway
examination, correct patient positioning to facilitate intubation, and the
ability to maneuver the fiberoptic scope through the airway.
• If proceeding with an awake fiberoptic intubation, the patient must also be
cooperative and well informed of the anesthetic plan.
Airway Anatomy
• The upper airway consists of the nose, mouth, pharynx, larynx, trachea, and mainstem
bronchi.
• There are two openings to the human airway: the nose, which leads to the nasopharynx, and
the mouth, which leads to the oropharynx.
• The pharynx is a U-shaped fibromuscular structure that extends from the base of the skull
to the cricoid cartilage at the entrance to the esophagus.
• At the base of the tongue, the epiglottis functionally separates the oropharynx from the
laryngopharynx (or hypopharynx).
• The larynx is composed of nine cartilages : thyroid, cricoid, epiglottic, and (in pairs)
arytenoid, corniculate, and cuneiform.
Airway Anatomy
Indications
• Awake FOI:
1. High aspiration risk (Full stomach , poorly controlled GERD , 2nd or 3rd trimester)
2. Anticipated difficult BMV (Beard , edentulous , OSA , old age , obese)
3. Upper airway obstruction (Tumors , hematomas , Ludwig angina , airway burns)
4. Congenital syndromes (Pierre Robin , Down , Treacher Collins)
5. Previous difficult or failed intubation
6. Known or suspected C- spine instability (Trauma , RA)
Indications
• Asleep FOI
1. Failed intubation
2. Desire for minimal cervical spine movement in patients who refuse awake
intubation
3. Anticipated difficult intubation when ventilation by mask appears easy
Contraindications
Preparations
• Airway Assessment :
Preparations
• Equipments :
Preparations
• Airway Anesthesia
Nasopharyngeal Drugs
Preparations
• Sedation
Technique
• Use sedative premedication cautiously, and not at all in the presence of
severe airway compromise.
• Anticholinergic premedication may be given to reduce secretions.
• Prescribe aspiration prophylaxis (such as ranitidine and sodium citrate)
preoperatively.
• Check all equipment in the anaesthetic room, attach monitoring and secure
intravenous access.
Technique
• Prepare the airway by achieving local anaesthesia.
• Spray the nasal mucosa with a vasoconstrictor if this is the chosen route.
• Having loaded the chosen endotracheal tube onto the fibreoptic scope
proceed via mouth or nose until the larynx is visualised.
• Pass the tube off the scope into the trachea and check for correct placement.
Complications
Resources
• Atlas Of Airway Management
• Core Topics In Airway Management
• Hagberg And Benumof ’s Airway Management
• Hung’s Difficult And Failed Airway Management
• Manual Of. Clinical Anesthesiology
• Oxford Handbook Of Anesthesia
• Morgan & Mikhail’s Clinical Anesthesiology
• Clinical Anesthesia Fundamentals
• Basics Of Anesthesia
• Fundamentals Of Anesthesia
