Video Laryngoscopy and Fiberoptic-Assisted Tracheal Intubation Periprocedural Care

Updated: Feb 28, 2019
  • Author: Sunil P Verma, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Periprocedural Care

Equipment

Equipment required for video laryngoscopy includes the following:

  • Fiberoptic bronchoscope with light source
  • Camera with monitor if intubation is to be projected to screen
  • Lidocaine 4%
  • Nasal trumpets, 28 and 36 French
  • Glycopyrrolate 0.2 mg (to be administered intravenously (IV) before start of the procedure)
  • Endotracheal (ET) tubes (see Treatment for additional information)
  • Warmed saline
  • Syringe, 12 mL
  • Oral airway
  • Carbon dioxide detector
  • Antifog solution or an alcohol pad
  • Suction tubing
  • Oxygen with cannula
Next:

Patient Preparation

Anesthesia

This procedure can be performed with the patient either awake or sedated. If the patient is likely to have a difficult airway, perform the procedure when the patient is awake, if possible. In some circumstances, the patient may be given mild IV sedation to make the procedure more comfortable.

For the awake patient, anesthesia should be provided to the following three regions before and during the procedure:

  • Nasal cavity (if nasal intubation is to be performed)
  • Pharynx
  • Larynx

Nasal anesthesia is provided by lightly coating the area around the nasal trumpets with lidocaine 4% jelly. After having the patient inhale phenylephrine 1% or oxymetazoline 0.05% nasal spray, coat a 28-French nasal trumpet with lidocaine 4% jelly and place it in one nasal passage. This should be serially dilated to accommodate a 36-French nasal trumpet, if possible.

Pharyngeal anesthesia is delivered by nebulizer. The patient should inhale nebulized 3 mL of lidocaine 4%.

Laryngeal anesthesia can be delivered in one of the following three ways:

  • Apply 1 mL of 4% lidocaine via the fiberoptic scope channel when the scope is positioned directly above the larynx
  • A bilateral superior laryngeal nerve block can be performed
  • A cotton ball soaked in lidocaine 4% can be used to apply the anesthesia; grasp the soaked cotton back with Jackson laryngeal forceps, then, with the tongue grasped, apply the cotton ball transorally to the epiglottic, hypopharynx, and vocal fold mucosal surfaces

Tracheal anesthesia, though not necessary, can be delivered. This can be done by injecting 2 mL of lidocaine 2% transtracheally.

Positioning

Patients can be seated or supine for fiberoptic intubation. If the patient is being intubated awake, the patient should be seated with the head of the bed elevated almost 90º. If the patient is being intubated under sedation, the traditional supine position with the head in a sniffing position suffices.

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