Awake fibre-optic Intubation

Dr Orlando Warner, Oxford, UK

Introduction

Awake fibreoptic intubation (AFOI) is often used in patients with difficult airways. Conscious sedation and analgesia are paramount to this technique. Remifentanil is of interest in this area as it provides sedation, analgesia, and an anti-tussive action and can attenuate the haemodynamic response to intubation. In addition, new concepts in target controlled infusion (TCI) technology (such as context detrimental time, time to peak onset, effect site compartment and rate constants) have allowed the introduction of Remifentanil TCI to clinical practice. Allowing the target plasma and effect site concentration to reach equilibrium, can guarantee consistent pharmacodynamic effects and allow safe and predictable sedation to be administered. Accurate pharmacokinetic control of sedation is now possible in the clinical setting of difficult airways and which allows conditions during instrumentation to be compared. This talk introduces this concept and provides a video demonstration of this technique to achieve conscious sedation during awake fibreoptic intubation in patients with bona fide difficult airways.

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