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notesawakeintubation

Awake intubations


Awake intubations

  • In OR and near anesthesia machine
  • Aspiration prophylaxis (Bicitra, H2 blocker, Reglan)
  • Robinul 0.2-0.4 to dry secretions
  • Versed 2-4 mg, Fentanyl 50-100 mcg
  • Devilbiss atomizer, 10 ml of 2% lidocaine or 0.45% tetracaine, with high-pressure oxygen source at 8 l/m
  • Atomizer at nostrils works best
  • Aerosolized lidocaine (4%, 4 ml) can also be used with a standard aerosolizer
  • Use lidocaine gel on Q-tips for nose
  • Patients can also gargle 4% lidocaine
  • Bill Lyman’s technique:
    • Versed 4 mg
    • Glycopyrrolate
    • Nebulize 3 ml of 4% lidocaine
    • Put tonsil sponges on tonsils with 5% viscous lidocaine
    • Pull tongue out and drop 10 ml of viscous lidocaine on back of tongue

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