The high flow topicalization technique for awake tracheal intubation

• Published in: Journal of clinical anesthesia Vol. 78; p. 110665
• Main Authors: Schechtman, Samuel A., Shah, Nirav, Cloyd, Benjamin H., Tremper, Kevin K., Healy, David W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2022; Elsevier Limited
• Subjects: Airway management; Continuous positive airway pressure; Fiber Optic Technology; Humans; Intubation; Intubation, Intratracheal - methods; Laryngoscopy - methods; Patient satisfaction; Success; Trachea; Wakefulness
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2022.110665

[...]we test for topicalization by spraying 2–3 mL of 4% lidocaine through an atomizer and ensuring for an abolished gag reflex (MADgic® Laryngo-Tracheal Mucosal Atomization Device; Teleflex®, Wayne, PA). Additionally, the application of HFNO may also benefit patients with partially obstructed airways undergoing awake tracheal intubation by reducing the work of breathing and airway resistance [7].In addition to improved oxygenation and airway topicalization, continuous positive airway pressure provided by HFNO [7] appears to optimize airway patency and visualization of anatomy during performance of awake tracheal intubation. In this brief discussion, we hope to describe that the early use of HFNO in addition to improving oxygenation as previously recommended [1–3,7], also appears to improve airway topicalization, success, and patient tolerance with awake tracheal intubation.Funding sources This work was supported solely by departmental funding.Declaration of Competing Interest Kevin K. Tremper PhD, MD is the founder and president of AlertWatch™ and holds patents and equity interest in the company.