NextGen Learning To Elevate Your Airway Practice
| Introduction | Rapid Review |
| Dive Deeper | The Deep Dive |
| Microskills | What’s Next |
Rapid Review (2:11min)
Dive Deeper (7:41min)
The Deep Dive: Topicalization + FOI (11:42min).
Summary of Key Steps
Topicalizing the airway is critical in preparing a patient for awake fiberoptic intubation (FOI). The goal is to provide adequate local anesthesia to key areas of the airway while minimizing patient discomfort and maintaining their ability to breathe and cooperate. Below are the steps and techniques commonly used for topicalization:
- Prepare the Nasal or Oral Route:
- For nasal intubation: Apply a vasoconstrictor (e.g., oxymetazoline) and coat the nasal passages with 2% lidocaine gel.
- For oral intubation: Spray 4% lidocaine directly into the mouth, targeting the posterior pharynx and tongue.
- Nebulize Lidocaine:
- Use 4% lidocaine in a nebulizer to deliver anesthetic throughout the upper airway. This step provides a uniform anesthetic effect and is well-tolerated by patients.
- Lidocaine Lollipop:
- Apply 5% lidocaine paste to an oral airway to create a lidocaine “lollipop” and have the patient slowly insert it into their oropharynx.
- MAD Atomizer:
- Attached to a 10cc syringe: spray 3-5 mL of 4% lidocaine through the device directly into the nasal passages or oral cavity to provide targeted and wide coverage.
- Spray-as-You-Go (SAYGO):
- Load 2-4% lidocaine into the working channel of the fiberoptic scope.
- As the scope advances, spray small amounts directly onto the epiglottis, arytenoids, and vocal cords for targeted anesthesia.
- Monitor and Oxygenate:
- Maintain oxygen delivery via nasal prongs or a facemask throughout the procedure.
- Observe the patient for comfort and any signs of anesthetic toxicity.
Tools of the Trade
Learn more about each of the items used in effectively topicalizing your patient. If you’re with us in person, snap on the QR code of each item and learn more. 🤚
| 5% Lidocaine Paste | MAD Atomizer |
| Oral Airway | Tongue Depressor |
| NRB w/nebulizer | Midazolam |
What’s Next
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