Awake intubation

Consideration: difficult to intubate vs difficult to ventilate
if difficult to ventilate → awake intubation

6 Steps

Nerve supply	location	effect
Trigeminal anterior ethmoid nasopalatine greater & lesser palatine	Nasal mucosa	Pain
Glossopharyngeal (lingual & pharyngeal branches)	pharyngeal wall posterior 1/3 tongue	gag glottic closure
Vagus internal branch of SLN RLN	hypopharynx larynx trachea	laryngospasm cough

Lignocaine bioavailability (Takaenoki 2016)

toxic plasma level 5µg/ml
seizure at 8µg/ml
cardiac arrest at 20µg/ml

(glycopyrrolate doubles the duration of LA)

lignocaine at least 4% (work better on mucosa)
6-8L/min ok (flow too high leads to tiny particles → go to lung instead of UAW)

When planning sedation for awake intubation, the patient typically requires less midazolam than the anesthesiologist

Andranik Ovassapian

Anxiolytics