Flexible scope intubation for anesthesia
- Carin A Hagberg, MD
Carin A Hagberg, MD
- Section Editor — Airway Management
- Helen Shaffer Fly Distinguished Professor
- Division Head of Anesthesiology, Critical Care and Pain Medicine
- The University of Texas MD Anderson Cancer Center
- Carlos Artime, MD
Carlos Artime, MD
- Associate Professor of Anesthesiology
- The University of Texas Medical School at Houston
The flexible bronchoscope is a device that can be used for indirect laryngoscopy for endotracheal intubation, and it is particularly useful when direct laryngoscopy is difficult or impossible, or would be dangerous. For awake intubation, flexible bronchoscopy is better tolerated than laryngoscopy with a standard laryngoscope.
This topic will discuss the equipment and techniques used for flexible bronchoscopic intubation, including patient preparation and sedation for awake flexible bronchoscopic intubation. Retrograde intubation using a percutaneous wire will also be discussed.
While the term "flexible fiberoptic intubation" has been used for this technique in anesthesia, newer bronchoscopes no longer use fiberoptic technology. Therefore, this topic will use the terms "flexible scope intubation" (FSI) for the technique and "flexible intubating scope" (FIS) for the device.
Other airway devices, techniques for endotracheal intubation, and management of the difficult airway for anesthesia are discussed separately. (See "Management of the difficult airway for general anesthesia" and "Airway management for induction of general anesthesia" and "Supraglottic devices (including laryngeal mask airways) for airway management for anesthesia in adults" and "Direct laryngoscopy and endotracheal intubation in adults".)
Flexible bronchoscopy for one-lung ventilation and for diagnostic purposes is also discussed separately. (See "Flexible bronchoscopy in adults: Overview" and "Flexible bronchoscopy in adults: Indications and contraindications" and "General principles of one lung ventilation" and "Lung isolation techniques".)
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- Flexible intubating scope
- Oral airway
- Other equipment
- AIRWAY ANATOMY
- PATIENT PREPARATION
- Aspiration prophylaxis
- Nasal preparation
- Awake intubation
- - Sedation
- - Airway anesthesia
- Topical anesthesia
- Nasal anesthesia
- Transtracheal injection
- Nerve blocks
- - Glossopharyngeal nerve block
- - Superior laryngeal nerve block
- - Nerve blocks for nasal cavity
- EQUIPMENT PREPARATION
- Oral intubation
- Nasal intubation
- Retrograde intubation
- Difficulty with the view
- Difficulty advancing the endotracheal tube
- SUMMARY AND RECOMMENDATIONS