Awake video laryngoscopy

 

Decision making:

Assessment

·     Hx

·     Ix

·     Ex

Discussion

·     Patient

·     Surgeon

Informed consent

·     Procedure

·     Expectations

·     Benefits

·     Risks

·     Alternatives

 

Prepare

Drugs

·     Pre-medication + reversal

·     Topicalisation

·     Induction

·     Resuscitation

Monitoring

·     SpO2

·     NIBP

·     ECG

·     Capno

Equipment

·     Usual airway equipment

·     Difficult airway trolley

·     Video laryngoscopy + hyperangulated blade

·     Bougie vs ETT with stylet

People

·     Nurse

·     Another doctor

 

Pre-medicate

Glycopyrrolate

·     4mg/kg

·     Reduce secretions -> improve topicalization

Midazolam

·     0.0125-0.025mg/kg

·     Anterograde amnesia

·     Anxiolysis

Remifentanil TCI

·     2mcg/mL during preparation

·     4-6mcg/mL at intubation

·     ↓Noxious stimulation, ↓airway reflexes

 

Topicalise

Nebulise

·     Lignocaine 2% 10mL

·     Flow rate ≤6L/min

Gargle

·     Lignocaine viscus 2% 10mL

Spray

·     Larynx and trachea under vision

·     MAD

·     2% lignocaine 10mL

 

Intubate

Position

·     Patient on the operating table

·     A bit of head up

·     Stand at head of the bed in usual position

Insertion

·     Get a view

·     Topicalise with MAD

·     Wait 30 seconds

·     Intubate

·     Anaesthetise

 

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