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Chapter 16 - Tracheal Intubation Using the Flexible Optical Bronchoscope

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
P. Allan Klock ,
Mridula Rai  and
Mansukh Popat
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

The flexible optical bronchoscope has unparalleled utility for difficult airway management and is part of every difficult airway management algorithm. The device can facilitate intubation for patients with airway tumours and bony or soft tissue abnormalities. It provides continuous visualisation of the airway during management, can be used to deliver local anaesthetics to the airway and is relatively less traumatic compared to other devices. Mastery of the device requires significant practice and the practitioner must use the device regularly to maintain skills. Several tips for success and pitfalls to be avoided are discussed.

Keywords

Difficult airway managementflexible intubation scopeflexible optical bronchoscopeintubating laryngeal mask airwaytracheal intubation
Type
Chapter
Information
Core Topics in Airway Management , pp. 140 - 152
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Asai, T, Shingu, K. (2004). Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope. Incidence, causes and solutions. British Journal of Anaesthesia, 92, 870–881.Google Scholar
Du Rand, IA, Blaikley, J, Booton, R, et al. (2013). British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax, 68(Suppl 1), i1–i44.CrossRefGoogle ScholarPubMed
Johnson, DM, From, AM, Smith, RB, From, RP, Maktabi, MA. (2005). Endoscopic study of mechanisms of failure of endotracheal tube advancement into the trachea during awake fiberoptic orotracheal intubation. Anesthesiology, 102, 910–914.Google Scholar
Law, JA, Morris, IR, Brousseau, PA, de la Ronde, S, Milne, AD. (2015). The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study. Canadian Journal of Anaesthesia, 62, 736–744.CrossRefGoogle Scholar
Marfin, AG, Iqbal, R, Mihm, F, et al. (2006). Determination of the site of tracheal tube impingement during nasotracheal fibreoptic intubation. Anaesthesia, 61, 646–650.Google Scholar
Ovassapian, A. (1996). Fibreoptic Endoscopy and the Difficult Airway. 2nd Ed. Philadelphia: Lippincott-Raven.Google Scholar

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