DAS: Awake Tracheal Intubation

Question 1

DAS Awake Tracheal Intubation Technique

Answer 1

Oxygenate
- Early HFNO 30-70L/min

Topicalise
- Lidocaine 10% spray 20-30 sprays over 5 mins to oral airway
- Or if nasal route co-phenylcaine spray
- Test topicalisation
1 spray of lidocaine 10% is 0.1ml = 10mg
1 bottle of co-phenylcaine is 2.5ml = 125mg lidocaine and 12.5mg phenylephrine
- when using bronchoscope further 3x sprays above and below cords of 2% lidocaine
Max dose 9ml/kg LBW

Sedate
- If required
- Remifentanil TCI minto Ce 1.0-3.0ng/ml
- Can consider 0.5-1mg midazolam only if 2nd anaesthetist is present

Perform
- Patient sitting up
- Ensure operator can see screen and monitoring
- Clear secretions
- Confirm tube placement with ETCO2 and direct visualisation

Question 2

DAS Awake Tracheal Intubation Managing complications

Answer 2

Oxygenation
- Clear obvious obstructions
- Reverse sedation
- Increase FiO2

Topicalise
- Ensure adequate up to 9ml/kg
- LAST management

Sedate
- Stop
- Consider reversal agents

Perform
- Limit attempts to 3 +1 further from more experienced operator
- Abandon procedure
- Suction
- Change tracheal tube type
- Call for help

Question 3

DAS Awake Tracheal Intubation: Failed intubation Algorithm

Answer 3

Call for help -> 100% O2 and stop sedation -> Is immediate airway management essential If no then postpone -> Is FONA appropriate if no then -> High risk GA