in which clinical scenario would awake fibreoptic nasal intubation be employed?

CLINICAL VIDEO

In which clinical scenario would awake fibreoptic nasalintubation be employed?Karim Kassam & Tasmin Rope

Northwick Park Hospital, London, HA1 3UJ, United Kingdom

Correspondence

Karim Kassam, Oral and Maxillofacial

Surgery, Northwick Park Hospital, London,

HA1 3UJ, United Kingdom.

Tel: +447866807608;

E-mail: drkarimkassam@gmail.com

Funding Information

No funding information provided.

Received: 6 October 2013; Revised: 19

October 2013; Accepted: 23 October 2013

Clinical Case Reports 2014; 2(1): 21

doi: 10.1002/ccr3.37

Key Clinical Message

The routine way to access the uncomplicated airway is via direct laryngoscopy.

When this is not possible, there are a number of other techniques to help visu-

alization such as the video laryngoscopy. These require a degree of mouth

opening. With almost complete trismus, the clinician should resort to awake fi-

breoptic nasal intubation to secure the airway.

Keywords

Difficult airway, fibreoptic, ludwigs angina.

An awake technique is chosen when it is considered

unsafe to anesthetize the patient before guaranteeing the

ability to secure their airway, usually when difficult laryn-

goscopy and difficult bag-mask ventilation are expected.

This was performed via the nasal route on a 19-year-old

man with 10 mm mouth opening with Ludwig’s Angina.

Ludwig’s angina is a rapidly progressing, potentially ful-

minant cellulitis involving the sublingual, submental, sub-

mandibular, and parapharyngeal spaces. Note the supra

and subglottic secretions and edema and the swollen aryt-

enoids and vocal cords caused by the infection.

Video 1. The video of this process is found in the online

version of this article.

ª 2014 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use,

distribution and reproduction in any medium, provided the original work is properly cited.

21