Capnography during fiberoptic bronchoscopy to verify tracheal intubation

Awake fibrecapnic intubation in head and neck cancer patients with difficult airways: new findings and refinements to the technique

Recently, we described an adaptation of awake fibreoptic intubation that we call awake fibrecapnic intubation. The aim of this study was to evaluate the efficacy and risk of complications with this novel technique in a consecutive case series of head and neck cancer patients known to have difficult airways. We prospectively studied 40 consecutive intubations in head and neck cancer patients prior to a diagnostic or surgical procedure. Following topical anaesthesia, a flexible bronchoscope was introduced into the pharynx; spontaneous respiration was maintained in all patients. A special suction catheter was advanced into the airway through the suction channel of the bronchoscope for carbon dioxide measurements. When four capnograms were obtained, the bronchoscope was railroaded over the catheter and a tracheal tube was placed. All adverse events and complications were recorded. There were no complications associated with the technique. The median (range) time to intubation was 3 min (1.5-15 min). All patients were intubated successfully, 39 (98%) of them using awake fibrecapnic intubation. There was one patient with severe tumour bleeding and acute airway obstruction caused by advancement of the tube over the bronchoscope. This was not considered to be a complication of the fibrecapnic technique. Awake fibrecapnic intubation is a safe and valuable technique in head and neck cancer patients with a difficult airway.

Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway

Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2-15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s.