Fiberoptic wake intubation | Intubation

Fiberoptic wake intubation

Fiberoptic awake intubation is the method of choice for difficult intubation conditions. A flexible bronchoscope is available for this purpose, which can be inserted into the trachea while the patient is awake and has received protective reflexes. Thus the spontaneous breathing of the patient is maintained.

Since the procedure can be very unpleasant for the patient, it is important that the mucous membranes are sufficiently anaesthetized in advance. Afterwards, the bronchoscope can be pushed through the nose or mouth with the tube threaded on to the entrance of the larynx. The bronchoscope has an additional opening through which anesthetic can then be applied to the vocal folds. Once this is done, the tube can be inserted further into the trachea. Only when the tube has been safely placed in the trachea is the anesthesia initiated.

Criotomy

The criotomy is the last possibility to ensure the ventilation of a patient. It is only used in so-called “cannot intubate, cannot ventilate” cases, i.e. in patients who cannot be ventilated with a mask or conventional intubation. This is an emergency, as the patient is otherwise at risk of suffocation.

Criotomy is a surgically invasive procedure in which the Ligamentum conium (hence the name), a ligament between the cartilage parts of the larynx, is opened from the outside with an approximately 3 cm long incision. A ventilation tube can then be inserted through this opening, which enables the patient’s oxygen supply to be ensured. However, this procedure only serves to bridge the oxygen supply in emergency situations. As soon as the situation allows, an alternative intubation procedure should be used.