awake intubation with a compact video laryngoscope to secure the airway

<meta charset="utf8"></head><body>困难气道中的清醒插管：一种灵活的视频喉镜方法

Airway management has developed substantially over the last 20 years, but difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality1. Patients with known or unknown pathologies of the base of the tongue, hypopharynx, glottic aperture, or trismus pose a risk of difficult or impossible facemask ventilation, supraglottic device placement, and tracheal intubation after the induction of general anesthesia1,2,3.
Standard preoperative airway examinations often fail to reveal these lesions due to discrete accompanying clinical signs and symptoms2,3. Awake flexible scope intubation is considered the gold standard in securing the airway in such cases because it allows for spontaneous respiration, preserves airway reflexes, and mitigates the risks of losing the airway or bronchopulmonary aspiration4. Despite its benefits, awake intubation remains an underused technique, even when indicated (around 1% of all intubations), due to reservations regarding its use related to lack of practice or the pressure of a busy operating theatre2,4. With the development of airway control devices, awake intubation now includes procedures employing flexible scopes, rigid or semirigid optical stylets, and video laryngoscopes5.
Nasopharyngeal flexible endoscopy, sometimes referred to as flexible nasopharyngoscopy, flexible nasolaryngoscopy, transnasal flexible laryngoscopy, or flexible fiberoptic nasopharyngolaryngoscopy, is a medical technique that aids the practitioner in examining the nasal passages, nasopharynx, oropharynx, hypopharynx, and larynx6. It is a routine instrument in ENT (ear, nose, and throat) practice and has the advantage of being minimally invasive and easy to handle7. Its use has expanded across different medical specialties, including maxillofacial surgery, anesthesiology, speech and language therapy, and neurology. In an office or hospital setting, flexible rhinolaryngoscopy provides a valuable assessment of the airway and alerts healthcare providers to the presence of pathological pharyngolaryngeal structures that may impact airway management.
The flexible fiberoptic endoscope used for the adult population has a rigid part designed to be used with one hand and a flexible fiber optic cable. The effective length of the scope is between 300 and 350 mm with a flexibility of 130&#730; to 160&#730;. The flexible tip has a length of 20 mm with a visualization angle of 80&#730; to 90&#730; in newer models. The depth of field can be easily adjusted with the handpiece roller, ranging from 3 to 60 mm. The diameter of the insertion tube may range from 3 mm to 4.5 mm, and certain models are equipped with a working or suction channel (Figure 1). Technology has advanced further, and the device has evolved from fiberoptic to new chip-on-the-tip flexible digital scopes, ensuring high-resolution imaging6,7.
Traditionally, practitioners perform awake flexible scope intubation using a fiberoptic bronchoscope with a 600 mm working length5. This protocol, based on a previous prospective study8, aims to describe in detail a technique for awake nasotracheal intubation using a 300 mm flexible rhino-laryngoscope.

<meta charset="utf8"></head><body>作者聚焦：使用柔性视频鼻喉镜推进清醒鼻气管插管

用于清醒鼻气管插管的柔性鼻喉镜

使用紧凑型视频喉镜进行清醒插管以保护气道

awake-intubation-with-compact-video-laryngoscope-to-secure

Research

JoVE Journal

Medicine

Awake Intubation with a Compact Video Laryngoscope to Secure the Airway

92 次观看. 首先，将患者置于手术台上的坐姿或半卧位。执行美国麻醉医师协会定义的监测程序。使用 300 至 350 毫米工作长度的柔性视频鼻喉镜评估气道，并使用最适合放置 ETT 的鼻孔。检查有无室间隔偏曲、骨刺和鼻甲肥大。检查咽部和声门旁间隙、声带和声门下区域到气管中部。在光纤引导下使用内窥镜的工作通道或弯曲的口咽导管，局部施用利多卡...

视频: 使用紧凑型视频喉镜进行清醒插管以保护气道

The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies obstructing airway access are at risk of airway management failure once they lose spontaneous respiration. Awake flexible scope intubation is considered the gold standard for controlling the airway in such patients. Following a feasibility trial involving 25 patients with challenging airways, this article presents a step-by-step protocol for awake nasotracheal intubation using a flexible video rhino-laryngoscope, which is significantly shorter than conventional intubating flexible scopes. The flexible video laryngoscope only exceeds the intubating tube length by a few centimeters, allowing the tube to closely follow the flexible scope during the procedure. Once the scope reaches the pharynx, it can be easily manipulated with one hand, enabling the operator to focus on the safe advancement of the scope-intubating tube assembly through the glottis. Based on previous results and experience gained, this article highlights the potential benefits of the technique: the opportunity for a minimally invasive "quick look" preoperatively to establish a final management plan, a more convenient and safer tool for navigating distorted anatomy with a lower chance of intubating tube impingement and airway injury, and a fast and smooth procedure resulting in improved patient satisfaction.

Presented here is a protocol for awake nasotracheal intubation using a flexible rhino-laryngoscope with a 300 mm working length. As this tool is minimally invasive and easy to manipulate, awake intubation performed with a flexible rhino-laryngoscope is well-tolerated, fast, and safe for patients with difficult airways.

Difficulties or failures in securing the airway still occur and can lead to permanent disabilities and mortality. Patients with head and neck pathologies ...