Techniques and complications of awake fibre-optic intubation - A Survey of Difficult Airway Society members

摘要

Background: Awake fibre-optic intubation (AFOI) is a recommended option for managing the anticipated difficult intubation; however, there is no recommended standard technique. We investigated current practice of AFOI among Difficult Airway Society members. Methods: A survey was distributed to members of the Difficult Airway Society (DAS). Questions focussed on technique, complications and caseload within the previous 2 years. Results: Of 588 respondents, most (313; 53%) had performed less than 5 AFOI in the previous 2 years; 61 (10%) had not performed any AFOI and were excluded from further analysis. Of those who had performed AFOI within the preceding 2 years (527), remifentanil was used most commonly for single-agent sedation (237; 45%). Most anaesthetists (253; 48%) combined co-phenylcaine and lidocaine for airway topicalisation. A spray-as-you-go technique for topical anaesthesia was used most frequently (398; 76%). Of respondents, 109 (21%) encountered complications. Of these, the most frequently reported complications were requiring three or more attempts (41) followed by desaturation <80% (34) and failed AFOI (32). There was no statistically significant difference in complication rate between sedation techniques. Conclusion: AFOI remains the gold standard technique for anticipated difficult airway management, but low case numbers is a cause for concern for skill maintenance and difficult airway training. A wide variation in anaesthetic technique for AFOI may be aided by national guidelines for awake tracheal intubation.