Guidelines for intubation under fiberoptic bronchoscopy in a University Hospital
Keywords:
Airway Management, Intubation, Ventilation, Guideline
Abstract
Introduction: The use of fiberoptic bronchoscopy as a tool for tracheal intubation is relatively new in our setting. Its availability has been increasing, and hence the need for anesthetists to receive adequate training in the use of this device. Knowledge and mastery of this technique, following all the necessary steps, is the starting point for the successful performance of a procedure.
Objective: These guidelines describe the technique for intubation using the fiberoptic bronchoscope at the Evaristo García University Hospital of the Colombian Department of Valle.
Methodology: This paper is based on a review of the literature, the authors’ experience, and a discussion forum.
Results: Presentation of the guidelines for intubation using fiber optic bronchoscope at the Evaristo García University Hospital. Description of the technique for constructing a mask for patient ventilation during tracheal intubation under fiberoptic bronchoscopy.
References
1. Conyers AB, Wallace DH, Mulder DS. Use of the fiberoptic bronchoscope for nasotracheal intubation: A case report. Can Anaesth Soc J. 1972;19:654-6.
2. Erb T, Hampl KF, Schurch M, et al. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg. 1999;89:1292-5.
3. Ovassapian A, Dykes MH, Golmon ME. A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. Anaesthesia. 1983;38:795-8.
4. Johnson C, Roberts JT. Clinical competence in the performance of fiberoptic laryngoscopy and endotracheal intubation: a study of resident instruction. J Clin Anesth. 1989;1:344-9.
5. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103:33-9.
6. Kheterpal S, Martin L, Shanks AM, et al. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110:891-7.
7. Villalonga A, Lapena C. La respuesta refleja a la laringoscopia y a la intubación traqueal. Rev Esp Anestesiol Reanim. 1990;37:373-7.
8. Ovassapian A, Yelich SJ, Dykes MH, et al. Blood pressure and heart rate changes during awake fiberoptic nasotracheal intubation. Anesth Analg. 1983;62:951-4.
9. Benumof JL. Management of the difficult adult airway with special emphasis on awake tracheal intubation. Anesthesiology. 1991;75:1087-110.
10. Ovassapian A, Dykes MH,: The role of fiberoptic endoscopy in airway management. Sem Anesth. 1987;6:93-104.
11. Abernathy JH 3rd, Reeves ST. Airway catastrophes. Curr Opin Anaesthesiol. 2010;23:41-6.
12. Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Br J Anaesth. 2003;91:31-9.
13. Tsai CJ, Chu KS, Chen TI, et al. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010;65:254-9.
14. Rai MR, Parry TM, Dombrovskis A, et al. Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded randomized controlled trial. Br J Anaesth. 2008;100:125-30.
15. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-77.
16. Gempeler RF, Díaz L. Intubación nasotraqueal guiada por fibrosocopio retromolar de Bonfils por vía oral. Rev. Colomb. Anestesiol. 2011;39:111-7.
17. Bocanegra JC, Rios AM. Intubación con paciente despierto con fibroscopio rígido bajo sedación con remifentanil. Rev Colomb Anestesiol. 2010;38:395-401.
18. Aoyama K, Takenaka I. Patil-Syracuse mask for fiberoptic intubation. Masui. 1999;48:1262-6.
19. Obana N, Komatsu K, Komoda S, et al. The anesthetic management of tracheal T-tube exchange using Patil-Syracuse mask. Masui. 1999;48:386-9.
20. Roberts JT. Preparing to use the flexible fiber-optic laryngoscope. J Clin Anesth. 1991;3:64-75.
21. Clark K, Lam LT, Gibson S, et al. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomized control trials. Anaesthesia. 2009;64:652-7.
22. Sklar BZ, Lurie S, Ezri T, et al. Lidocaine inhalation attenuates the circulatory response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1992;4:382-5.
23. Venus B, Polassani V, Pham CG. Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation. Crit Care Med. 1984;12:391-4.
24. Udezue E. Lidocaine inhalation for cough suppression. Am J Emerg Med. 2001;19:206-7.
25. Kunda P, Kutralam S, Ravishankar M. Local anesthesia for awake fiberoptic nasotracheal intubation. Acta Anaesthesiol Scand. 2000;44:511-6.
26. Ibarra P, Robledo B, Galindo M, et al. Normas mínimas 2009 para el ejercicio de la anestesiología en Colombia. Comité de Seguridad. Rev Colomb Anestesiol. 2009;37:235-53.
27. Bein B, Wortmann F, Meybohm P, et al. Evaluation of the pediatric Bonfils fiberscope for elective endotracheal intubation. Paediatr Anaesth. 2008;18:1040-4.
28. Simmons ST, Schleich AR. Airway regional anesthesia for awake fiberoptic intubation. Reg Anesth Pain Med. 2202;27:180-92.
29. Ramesh S. Fiberoptic Airway Management in Adults and Chidren. Indian J Anaesth. 2005;49:293-9.
30. Michelson A, Schuster B, Kamp HD. Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation. Arch Otolaryngol Head Neck Surg. 1992;118:937-9.
31. Kumar CM, Lawler PG. Paranasal sinusitis: a complication of nasotracheal intubation. Br J Anaesth. 1986;58:1205.
32. Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991;99:1093-6.
33. Katz RI, Hovagim AR, Finkelstein HS, et al. A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation. J Clin Anesth.1990;2:16-20.
34. Superior laryngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders; 1999. p. 211-12.
35. Reed AP. Preparation for intubation of the awake patient. Mt Sinai J Med. 1995;62:10-20.
36. Translaryngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders;1999. p. 215-6.
37. Glossopharyngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders; 1999. p. 205-8.
38. Sutherland AD, Williams RT. Cardiovascular responses and lidocaine absorption in fiberoptic assisted awake intubation.Anesth Analg. 1986;65:389-91.
39. Parkes SB, Butler CS, Muller R. Plasma lignocaine concentration following nebulization for awake intubation. Anaesth Intensive Care. 1997;25:369-71.
40. Fulling PD, Roberts JT. Fiberoptic intubation. Int Anesthesiol Clin. 2000;38:189-217.
41. Ovassapian A, Yelich J, Dykes MHM, et al. Fiberoptic nasotracheal intubation- incidence and causes of failure. Anesth Analg. 1983;62:692-5.
42. Boysen PG. Fiberoptic instrumentation for airway management. Annual Refresher Course Lectures; 1992.
43. Maktabi MA, Hoffman H, Funk G, et al. Laryngeal trauma during awake fiberoptic intubation. Anesth Analg. 2002;95:1112-4.
44. Roberts JT, Abouleish AE, Curlin FJ, et al. The failed intubation: maximizing successful management of the patient with a compromised or potentially compromised airway. En: Roberts JT, editor. Clinical management of the airway. Philadelphia:W.B. Saunders; 1994. p. 187-218.
45. Hillman DR, Platt PR, Eastwood PR. The upper airway during anesthesia. Br J Anaesth. 2003;91:31-9.
46. Durga VK, Millns JP, Smith JE. Manoeuvres used to clear the airway during fibreoptic intubation. Br J Anaesth. 2001;87:207-11.
47. Woodall NM, Harwood RJ, Barker GL. Complications of awake fiberoptic intubation without sedation in 200 healthy anaesthetists attending a training course. Br J Anaesth. 2008;100:850-5.
48. Koppel JN, Reed AP. Formal instruction in difficult airway management. A survey of anesthesiology residency programs. Anesthesiology. 1995;83:1343-6.
49. Cooper SD, BenumofJL.Teaching the management ofthe difficult airway: the UCSD airway rotation. Anesthesiol. 1994;81:A1241.
50. Hershey MD, Hannenberg AA. Gastric distention and rupture from oxygen insuflation during fiberopticintubation. Anesthesiology. 1996;85:1479-80.
51. Siegel M, Coleprate P. Complication of fiberoptic bronchoscope. Anesthesiol. 1984;61:214-5.
52. Heidegger T, Gerig HJ, Ulrico B, Schnider TW. Structure and process quality illustrated by fiberoptic intubation: analysis of 1,612 cases. Anaesthesia. 2003;58:734-9.
2. Erb T, Hampl KF, Schurch M, et al. Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients. Anesth Analg. 1999;89:1292-5.
3. Ovassapian A, Dykes MH, Golmon ME. A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. Anaesthesia. 1983;38:795-8.
4. Johnson C, Roberts JT. Clinical competence in the performance of fiberoptic laryngoscopy and endotracheal intubation: a study of resident instruction. J Clin Anesth. 1989;1:344-9.
5. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103:33-9.
6. Kheterpal S, Martin L, Shanks AM, et al. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110:891-7.
7. Villalonga A, Lapena C. La respuesta refleja a la laringoscopia y a la intubación traqueal. Rev Esp Anestesiol Reanim. 1990;37:373-7.
8. Ovassapian A, Yelich SJ, Dykes MH, et al. Blood pressure and heart rate changes during awake fiberoptic nasotracheal intubation. Anesth Analg. 1983;62:951-4.
9. Benumof JL. Management of the difficult adult airway with special emphasis on awake tracheal intubation. Anesthesiology. 1991;75:1087-110.
10. Ovassapian A, Dykes MH,: The role of fiberoptic endoscopy in airway management. Sem Anesth. 1987;6:93-104.
11. Abernathy JH 3rd, Reeves ST. Airway catastrophes. Curr Opin Anaesthesiol. 2010;23:41-6.
12. Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Br J Anaesth. 2003;91:31-9.
13. Tsai CJ, Chu KS, Chen TI, et al. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010;65:254-9.
14. Rai MR, Parry TM, Dombrovskis A, et al. Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded randomized controlled trial. Br J Anaesth. 2008;100:125-30.
15. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-77.
16. Gempeler RF, Díaz L. Intubación nasotraqueal guiada por fibrosocopio retromolar de Bonfils por vía oral. Rev. Colomb. Anestesiol. 2011;39:111-7.
17. Bocanegra JC, Rios AM. Intubación con paciente despierto con fibroscopio rígido bajo sedación con remifentanil. Rev Colomb Anestesiol. 2010;38:395-401.
18. Aoyama K, Takenaka I. Patil-Syracuse mask for fiberoptic intubation. Masui. 1999;48:1262-6.
19. Obana N, Komatsu K, Komoda S, et al. The anesthetic management of tracheal T-tube exchange using Patil-Syracuse mask. Masui. 1999;48:386-9.
20. Roberts JT. Preparing to use the flexible fiber-optic laryngoscope. J Clin Anesth. 1991;3:64-75.
21. Clark K, Lam LT, Gibson S, et al. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomized control trials. Anaesthesia. 2009;64:652-7.
22. Sklar BZ, Lurie S, Ezri T, et al. Lidocaine inhalation attenuates the circulatory response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1992;4:382-5.
23. Venus B, Polassani V, Pham CG. Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation. Crit Care Med. 1984;12:391-4.
24. Udezue E. Lidocaine inhalation for cough suppression. Am J Emerg Med. 2001;19:206-7.
25. Kunda P, Kutralam S, Ravishankar M. Local anesthesia for awake fiberoptic nasotracheal intubation. Acta Anaesthesiol Scand. 2000;44:511-6.
26. Ibarra P, Robledo B, Galindo M, et al. Normas mínimas 2009 para el ejercicio de la anestesiología en Colombia. Comité de Seguridad. Rev Colomb Anestesiol. 2009;37:235-53.
27. Bein B, Wortmann F, Meybohm P, et al. Evaluation of the pediatric Bonfils fiberscope for elective endotracheal intubation. Paediatr Anaesth. 2008;18:1040-4.
28. Simmons ST, Schleich AR. Airway regional anesthesia for awake fiberoptic intubation. Reg Anesth Pain Med. 2202;27:180-92.
29. Ramesh S. Fiberoptic Airway Management in Adults and Chidren. Indian J Anaesth. 2005;49:293-9.
30. Michelson A, Schuster B, Kamp HD. Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation. Arch Otolaryngol Head Neck Surg. 1992;118:937-9.
31. Kumar CM, Lawler PG. Paranasal sinusitis: a complication of nasotracheal intubation. Br J Anaesth. 1986;58:1205.
32. Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991;99:1093-6.
33. Katz RI, Hovagim AR, Finkelstein HS, et al. A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation. J Clin Anesth.1990;2:16-20.
34. Superior laryngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders; 1999. p. 211-12.
35. Reed AP. Preparation for intubation of the awake patient. Mt Sinai J Med. 1995;62:10-20.
36. Translaryngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders;1999. p. 215-6.
37. Glossopharyngeal block. En: Brown D, editor. Atlas of regional anesthesia, 2nd ed. Philadelphia, PA: Saunders; 1999. p. 205-8.
38. Sutherland AD, Williams RT. Cardiovascular responses and lidocaine absorption in fiberoptic assisted awake intubation.Anesth Analg. 1986;65:389-91.
39. Parkes SB, Butler CS, Muller R. Plasma lignocaine concentration following nebulization for awake intubation. Anaesth Intensive Care. 1997;25:369-71.
40. Fulling PD, Roberts JT. Fiberoptic intubation. Int Anesthesiol Clin. 2000;38:189-217.
41. Ovassapian A, Yelich J, Dykes MHM, et al. Fiberoptic nasotracheal intubation- incidence and causes of failure. Anesth Analg. 1983;62:692-5.
42. Boysen PG. Fiberoptic instrumentation for airway management. Annual Refresher Course Lectures; 1992.
43. Maktabi MA, Hoffman H, Funk G, et al. Laryngeal trauma during awake fiberoptic intubation. Anesth Analg. 2002;95:1112-4.
44. Roberts JT, Abouleish AE, Curlin FJ, et al. The failed intubation: maximizing successful management of the patient with a compromised or potentially compromised airway. En: Roberts JT, editor. Clinical management of the airway. Philadelphia:W.B. Saunders; 1994. p. 187-218.
45. Hillman DR, Platt PR, Eastwood PR. The upper airway during anesthesia. Br J Anaesth. 2003;91:31-9.
46. Durga VK, Millns JP, Smith JE. Manoeuvres used to clear the airway during fibreoptic intubation. Br J Anaesth. 2001;87:207-11.
47. Woodall NM, Harwood RJ, Barker GL. Complications of awake fiberoptic intubation without sedation in 200 healthy anaesthetists attending a training course. Br J Anaesth. 2008;100:850-5.
48. Koppel JN, Reed AP. Formal instruction in difficult airway management. A survey of anesthesiology residency programs. Anesthesiology. 1995;83:1343-6.
49. Cooper SD, BenumofJL.Teaching the management ofthe difficult airway: the UCSD airway rotation. Anesthesiol. 1994;81:A1241.
50. Hershey MD, Hannenberg AA. Gastric distention and rupture from oxygen insuflation during fiberopticintubation. Anesthesiology. 1996;85:1479-80.
51. Siegel M, Coleprate P. Complication of fiberoptic bronchoscope. Anesthesiol. 1984;61:214-5.
52. Heidegger T, Gerig HJ, Ulrico B, Schnider TW. Structure and process quality illustrated by fiberoptic intubation: analysis of 1,612 cases. Anaesthesia. 2003;58:734-9.
How to Cite
1.
Lema F. E, Medina H, Gonzalez C, Hoyos CE, Tafur Betancourt LA. Guidelines for intubation under fiberoptic bronchoscopy in a University Hospital. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Jul. 2];40(1):60-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/867
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2012-01-01
How to Cite
1.
Lema F. E, Medina H, Gonzalez C, Hoyos CE, Tafur Betancourt LA. Guidelines for intubation under fiberoptic bronchoscopy in a University Hospital. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Jul. 2];40(1):60-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/867
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Clinical Practice Guides
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