Name: ACA- Hung 4e- Upper Airway Anesthesia for Awake Intubation

Description: ACA- Hung 4e- Upper Airway Anesthesia for Awake Intubation

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Upload Date: 2023-11-24T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
Awake intubation can be performed rapidly and effectively if optimum airway anesthesia is provided. The following video will show an easy and effective three step technique of topical anesthesia of the upper airway. The equipment required includes 2% lidocaine viscous, 4% lidocaine solution, a disposable mouth swab, an EZ-Spray atomizer, gauze pledgets, and a Jackson forceps. After soaking the mouth swab in 2% lidocaine viscous, the patient is instructed to gradually insert the swab and apply thoroughly to the posterior aspect of the tongue and the oral pharynx.
This patient controlled application can be repeated if needed. With ten milliliters of 4% lidocaine in the chamber, and with 8 liters of oxygen flow per minute, the EZ-Spray atomizer can deliver lidocaine to the upper airway through either the nasal cavity or through the mouth, depending on the chosen route of intubation. For oral intubation, gentle tongue traction can be used to open the oral pharyngeal space.
The nozzle is held inside the mouth and the spray first directed posteriorly to the back of the tongue and to the posterior pharynx, and then directed downward to the supraglottic area and trachea. The patient is instructed to breathe deeply through the mouth, synchronizing with the application of the EZ-Spray, until delivery of the lidocaine solution is complete. For nasal intubation, similar methods can be used to deliver the atomized lidocaine through the nose and to the upper airway by having the patient breathe through the chosen nostril.
To produce an intense block of the internal branch of the superior laryngeal nerve, a cotton pledget soaked in 4% lidocaine can be held by the Jackson forceps and applied against the mucosa of the piriform fossa. With gentle tongue traction to open up the oral pharyngeal space, the lidocaine pledget held by the Jackson forceps can be applied to the piriform fossa for 30 seconds on both sides. In summary, sensation of the upper airway can be effectively anesthetized by three simple steps.
First, application of lidocaine viscous to the posterior tongue using mouth swabs, followed by lidocaine atomization with the EZ-Spray synchronized with patient's respiratory efforts. And finally, applying the lidocaine pledget to the piriform fossa using the Jackson forceps. This three step technique has proven to provide intense upper airway anesthesia for awake intubation for thousands of patients in our institution.

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