Regional anaesthesia for awake intubation

Abstract

Awake intubation has stood the test of time, as a gold standard therapy for anticipated difficult airway management where performance, time and ease, patient’s comfort and safety primarily depend on the quality of upper airway anaesthesia provided either topically or by regional blocks. The NAP4 identified numerous cases where Awake Fibreoptic Intubation (AFOI) was indicated but was not used. The project did not enable us to determine why AFOI was not used but there were cases suggesting lack of skills, lack of confidence, poor judgement and in some cases lack of suitable equipment being immediately available. This latter problem was prevalent in ICU. Awake intubation should be used whenever it is indicated.