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

Abstract

BackgroundAwake 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. MethodsA survey was distributed to members of the Difficult Airway Society (DAS). Questions focussed on technique, complications and caseload within the previous 2 years. ResultsOf 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. ConclusionAFOI 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.