What Is an Awake Intubation?

In order to keep the airway open, the sputum or blood in the trachea should be aspirated in time to prevent hypoxia and carbon dioxide accumulation in patients, and effective artificial or mechanical ventilation should be performed.

Conscious tracheal intubation

Right!

In order to keep the airway open, the sputum or blood in the trachea should be aspirated in time to prevent hypoxia and carbon dioxide accumulation in patients, and effective artificial or mechanical ventilation should be performed.

Conditions for selecting an intubation tube

Awake endotracheal intubation is appropriate for anyone who is estimated to have difficulty in tracheal intubation, or who has one of the following conditions: airway insufficiency obstruction, such as excessive sputum, hemoptysis, and neck mass compression of the trachea; Pyloric obstruction,

Specific method of sober intubation

1. Give the patient a proper explanation, focusing on things that need to be coordinated, such as relaxing the muscles of the whole body, maintaining deep and slow breathing, not holding your breath and nausea, etc., in order to win the patient's full cooperation.

2. The use of appropriate pre-anesthetic medications such as haloperidine, pethidine or promethazine, and atropine can calm patients, reduce throat reflexes and reduce secretions, which is conducive to conscious intubation.

3 To ensure the smooth intubation, the technique should be as light, slow and correct as possible.

4 Comprehensive anesthesia of the laryngotracheal mucosal surface is the key to successful awake intubation.

5. One to two minutes after the epidural anesthesia of the mucosa is completed, a sober tracheal intubation can be performed as described above.

Method for anesthesia of throat mucosa surface

(1) Anesthesia of the mucosa of the throat: Use 1% tetracaine or 2% -4% lidocaine to spray three times in sequence: spray the back half of the tongue and soft palate first; ask the patient after 1-2 minutes Open your mouth and make a long "ah" sound at the same time, spray for the pharyngeal wall and throat; After 1-2 minutes, use the laryngoscope as a tongue depressor to gently lift the root of the tongue, point the sprayer, etc. at the throat, and suck deeply in the patient Spray when angry. The total amount of 1% tetracaine or 2% -4% lidocaine used in the three sprays is generally limited to 2-3m1.

(2) Tracheal mucosal surface anesthesia: There are two methods:

1) Transcranial membrance puncture injection method; after the anesthesia of the larynx is completed, the patient takes the head and tilts back, fixes the puncture point between the thyroid cartilage and the ring cartilage (the cical cartilage), and holds 1% tetracaine ( Or 2% lidocaine) 2m1, a syringe with a 23-gauge needle for vertical piercing through the cyclomembrane into the trachea. After confirming that the needle tip is in the correct position by aspiration, ask the patient to take a deep breath and quickly inject anesthetic at the end of expiration and the beginning of inspiration. At this time, the patient often coughs, and in order to avoid stabbing the tracheal mucosa, the needle needs to be withdrawn quickly. Transcranial membrane puncture may puncture subglottic tissue or vocal cords. Therefore, some people have suggested moving the puncture point down to the gap between the annular cartilage and the second tracheal ring (Figure 42-21). The anesthesia effect of this method is indeed reliable, and it is suitable for patients with difficult mouth opening, but it is easy to irritate patients with severe cough and bronchospasm. To avoid such pain, the following method can be used.

2) Glottic injection; after the anesthesia of the throat is completed, use a laryngoscope to reveal the glottis. The right hand holds 1% tetracaine (or 2% lidocaine) 21xll, and the front band is truncated to 8-10cm. For a syringe with an epidural catheter, insert the front end of the catheter into the upper end of the trachea under direct vision, and then slowly inject the anesthetic while rotating the syringe. After the injection, the patient is instructed to cough several times to obtain anesthesia of the mucosa of the upper trachea, subglottis and epiglottis. This method can significantly reduce and lighten the suffering of patients.

(3) Nasal mucosal surface anesthesia: For nasal intubation intubation, it is best to use 4% to 5% cocaine. Because it also has local vasoconstriction, first use 1ml nose drops, and then use cocaine cotton to fill the posterior nasal cavity. Alternatively, 0.5% to 1% tetracaine and ephedrine mixed solution can be used to perform epiephedrine according to the above method. It can also be used as a direct nasal spray.