local anesthesia used in fiber optic intubations

  1. CRNAs/SRNAs,

    Could you explain the common protocols/techniques used in your practice to adequately anesthetize the nasal cavity, oro/nasopharynx, and the vocal cords before a fiber optic intubation.

    Thanks
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  2. 2 Comments

  3. by   gaspassah
    3ccs 1% lido to bilateral superior laryngeal nerves then 3 cc's 1% lido through the crico thyroid membrane. this is done after having the pt breath in nebulized lidocaine for about 20 minutes. should adequately anesthetize above the cords the cords and some of the recurrent laryngeal nerves below the cords. it's workd for me
    d
  4. by   chicago bsn 2005
    i'm not a crna, but i worked as a tech for a while. i can tell you they sprayed cetacaine, warning them it smelled like bananas, and asked them to swallow. then i'd stick a glob of xylocaine on a tongue depressor, making sure it got all over the back of the tongue. we let them suck on it like a lolipop. we knew it took if they didn't gag with the ovasapian airway, instructing them to think of it like a whistle, (or by touching around back there with the tongue depressor for those who prefered the tongue pull). then, down the med port on the scope, 4cc of i think it was 4% lidocaine directly on the visualized cords, withdrawing immediately until that set before intubating. the other way to do the cords was transtracheal, with the same 4cc of 4% in a 10cc syrynge to afford confirming placement by aspirating air, using a 20G angiocath. this was typically all done with midaz on board. it also helped when we "protected their eyes," covering them with a sterile towel. one other thing we did was soften the tube during all this numbing by putting it in a hot bottle of sterile water, 10cc syringe attached and ready to go. i could carry on, but this is pretty much how most of the people did things where i worked. and your tech's will appreciate it if you use the suction and the hot water left from softening the tube to clean the mucus out of the suction line before it dries up in there. it's damaging to the scopes. not to mention, unsanitary.
    Last edit by chicago bsn 2005 on Feb 11, '05

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