Difficult Airway Society awake intubation guidelines: supraglottic airway-guided flexible bronchoscopic intubation as an alternative

作者：P. Wong, W. Lim · 发表于：Korean Journal of Anesthesiology · 年份：2020 · DOI：10.4097/kja.20174 · 被引用次数：4 · 研究领域：Medicine

been published [1]. We agree that the use of supraglottic airway devices (SADs) as a conduit for awake tracheal intubation warrants future investigation. We recently reported a case series of awake supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI) [2], a technique that may offer additional advantages to conventional FBI. The technique allows three preliminary tests in the awake patient before proceeding with SAGFBI and the subsequent induction of anesthesia. 1. “Awake test insertion” of the SAD determines if it can be inserted into a patient with moderately restricted mouth opening. The oral route may be preferred for awake intubation because of issues with surgical access, the presence of nasal pathology, or an increased risk of epistaxis. In our case series [2], we successfully inserted an Ambu Auragain(Ambu A/S, Ballerup, Denmark) size 3 into patients with interdental distances of 16 and 20 mm despite the product specifications recommending a required distance of 21 mm for insertion. We warmed the SAD to soften it in order to facilitate its insertion. 2. The “awake look” (along with other awake intubation techniques) allows evaluation of the periglottic region to identify any anatomical distortion or local pathology that may cause difficulties with intubation or indicate that a different technique for securing the airway should be used, e.g., front-of-neck access. 3. “Awake test ventilation” confirms whether ventilation via SADs is possible or not in an...