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Case 15 - Awakefiberoptic intubation

from Section I - Neuroanesthesia

Published online by Cambridge University Press:  03 May 2011

By
Heather Hervey-Jumper  and
Christopher R. Turner
Edited by
George A. Mashour  and
Ehab Farag
George A. Mashour
Affiliation:
University of Michigan
Ehab Farag
Affiliation:
Cleveland Clinic
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Summary

Awake fiberoptic intubation (AFOI) has the potential to trigger hypertension, tachycardia and hypoxia or hypercarbia. Patients who require fiberoptic-guided endotracheal intubation for the clipping or coiling of an intracranial aneurysm pose particular challenges for the safe completion of both procedures. This chapter presents a case study of a 56-year-old female with a poorly documented history of difficult intubation presented for elective clipping of a middle cerebral artery aneurysm. The case discussion highlights the considerations for awake endotracheal intubation in the patient with an unsecured aneurysm. The indications for AFOI in this case are essentially the same as for any difficult airway: concern for the ability to visualize the glottic opening via direct laryngoscopy combined with concern for the ability to mask ventilate. Hypercarbia or hypoxia during an awake fiberoptic intubation are frequently due to loss of respiratory efforts in a narcotized patient.

Keywords

craniotomiesright-sided acoustic neuromatransesophageal echocardiographyvenous air embolismvenous vasculature
Type
Chapter
Information
Case Studies in Neuroanesthesia and Neurocritical Care , pp. 48 - 50
Publisher: Cambridge University Press
Print publication year: 2011

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