ANZCA Bulletin June 2011 - Australian and New Zealand College of ...

ANAESTHESIA IN WA
CONTINUED
FREMANTLE HOSPITAL:
AWAKE FIBREOPTIC
INTUBATION COURSE
DR ANTHEA WILLIAM
AIRWAY FELLOW, FREMANTLE HOSPITAL
This twice-yearly course commenced
at Fremantle Hospital in 2007 and
is open to local anaesthetic trainees
and consultants. The course uses
participants as endoscopy subjects
thereby providing practical training on
human live subjects in the technique of
awake fi breoptic intubation. The course
is sponsored by Olympus who provide
VISERA Intubation Videoscopes with
viewing screens and lunch on the
second day.
The course is held over two half days.
There are two main supervisors, up
to fi ve lecturers, two anaesthetic
technicians to assist with the practical
procedures and a maximum of six
participants.
The fi rst afternoon includes a series of
lectures covering the following topics:
- Indications and contra-indications of
awake and asleep fi breoptic intubation.
- Equipment and physics of fi breoptic
scopes.
- Anatomy of the airway.
- Preparation of the patient.
- Technique of AFOI and adjuncts used.
- Troubleshooting.
The lectures are followed by a fi breoptic
endoscope dexterity session on
mannequins.
The awake fi breoptic intubation session
takes place the following morning in
theatre with full resuscitation facilities
available. All participants are instructed
to fast for four hours and are advised
that the procedure can be halted or
abandoned at any point if they fi nd it too
uncomfortable. This has never happened
in the four years that the course has
been held.
The subject has non-invasive blood
pressure, pulse oximetry and
electrocardiogram (ECG) applied and
recorded fi ve-minutely. A 20-gauge
cannula is inserted and IV glycopyrrolate
administered for its antisialagogue
effect. Topical lignocaine is limited to a
maximum of 9 mg/kg. Co-phenylcaine
is sprayed into each nostril followed by
nebulized 4 per cent lignocaine. After
this initial topicalisation, four of the fi ve
remaining participants takes turns in
performing nasendoscopy with further
airway topicalisation to the level of
the larynx. The fi fth participant then
proceeds through the vocal cords to
the carina and passes a soft-tipped
size 6.0 fastrach endotracheal tube
over the endoscope into the trachea.
Using this routine, each participant
performs four nasendoscopies and one
endotracheal intubation and witnesses
20 nasendoscopies and fi ve intubations.
Airway anaesthesia usually lasts around
90 minutes and the supervisors ensure
each participant has full sensation and
laryngeal co-ordination prior to the
commencement of the course lunch.
In the seven courses that have been
run to date, there have been no
major complications and endoscopy
and intubation were well tolerated.
Participants have enjoyed the course
and all found it a valuable learning
experience.
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ANZCA Bulletin June 2011