Failed fibreoptic intubation: 70° rigid nasendoscope and Fro
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Awake fibreoptic intubation is considered as gold standard in difficult airway scenarios with a success rate of 87–100%. Common causes for failed awake fibreoptic intubation include severe distorted airway, lack of experience, presence of secretions or blood and inadequate topical anaesthesia.The steps to use 70° rigid nasendoscope with Frova introducer for tracheal intubation are as follows: In step 1, patient is asked to open the mouth and protrude the tongue in supine position. In step 2, 70° nasendoscope is introduced inside the mouth under direct vision to position its tip in front of the uvula without making contact with any structures inside the mouth and the larynx will be visible. This procedure does not require local anaesthesia. If larynx is partially visible, nasendoscope can be tilted upwards by 10°–20° against lateral incisor and canine teeth space. In step 3, local anaesthesia is sprayed directly on the posterior pharyngeal wall and the base of the tongue. In step 4, Frova intubating introducer is introduced under vision inside the mouth and then under video assistance-guided between the vocal cords into the trachea. Local anaesthesia can be sprayed through the hollow stylet of Frova in the trachea and also on the vocal cords before advancing into the trachea. In step 5, correct positioning can be verified by removing the stylet and attaching the end-tidal carbon dioxide to the Frova introducer. In step 6, endotracheal tube is railroaded over the Frova introducer into the trachea.We report two cases of failed fibreoptic intubation in obstructed airway where 70° rigid nasendoscope in combination with Frova intubating introducer was successfully used...
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