in which clinical scenario would awake fibreoptic nasal intubation be employed?
TRANSCRIPT
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: [email protected]
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.
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