Episode 17: Awake intubation

In this episode I discuss awake intubation.  I discuss the indications, techniques, nerve blocks, sedation and different methods of performing awake intubation.

Slides to go along with the podcast are here: awake intubation slides

The youtube video of the MGH anesthesiologist intubating himself is here: self-intubation

 

6 Replies to “Episode 17: Awake intubation”

  1. Wonderful episode! Very useful and a great review of topicalization steps for awake intubations. Could you do an episode sometime on airway management in out-of-department situations? (ICU/floor calls, ER, oral/facial trauma situations, etc.) Thank you for all of your hard work on these podcasts!

  2. Thank you for the comprehensive review on awake FOI. Regarding the nasal route to FOI and ETT size, you mentioned using a smaller tube size for ease of placement. Are you referring to a normal ETT or a Nasal RAE tube or both? Do you ever find that the smaller size limits your depth and ability to reach the vocal cords? Do you recommend a half size or full size smaller than you would use for a normal intubation? Thank you for the podcasts!

    1. Hi Catherine,

      You are absolutely right, for nasal rae tubes you really can’t downsize. You have to use the size that will give you enough depth. Usually this ends up being a 6-0 or 6-5 in a very short woman, a 7-0 for most women, and a 7-5 for most men. If you are using a regular ETT, then you can consider downsizing a half size from what you would normally do.

      All the best,
      Jed

  3. Love the podcast, keep up the great work. I was asked to provide topicalization for an awake nasal bronchoscopy recently and used this technique with good success. My question is regarding the lidocaine dosing. Do you have any concerns about systemic toxcicity? Are you calculating a total max dose that you use before your start? Interested in your thoughts. Thank you.

    1. Hi Derek,
      Great question. It’s always important to think about toxicity when using any medication. Lidocaine toxicity is, of course, a possibility when doing this procedure. However, in practice, most of us find that you don’t reach that level. This is probably due to the fact that much of it is not actually making it into the lungs through the nebulizer, and there is slow absorption through the G.I. tract when some is swallowed. In general, if you put about 5 mL in the nebulizer, a couple of lollipops with paste in the mouth, a couple of ccs in the atomizer, and maybe a cc or 2 through a trans tracheal block, you are likely below systemic toxicity levels. It is probably prudent, however, to avoid giving additional IV lidocaine with induction once the tube is in.

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