 Description:
The
fiberoptic bronchoscope is constructed of fiberoptic bundles and
cables encased in a slender, waterproof sheath from the handle
to the tip. The cable system permits manipulation of the tip of
the bronchoscope by adjustments at the handle, the operating end
of the device.
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Indications:
- Routine
intubation, difficult intubation, abnormal airway, compromised
airway
- Neck
extension not desirable
- Assessment
of tube placement
- Risk
of dental damage
- Removal
of secretions and mucus plugs
- Lack
of skill
- Lack
of functioning equipment
- Inability
to oxygenate patient
- Major
bleeding in the airway
Advantages:
- Excellent
visualization of the airway
- Minimal
hemodynamic stress when properly performed
- Oral
or nasal intubation is possible in the adequately prepared patient
- Ability
to apply topical anesthesia and insufflate oxygen during intubation
- Expensive
- Requires
careful maintenance
- Presence
of blood/secretions impairs visualization
- Requires
practiced expertise for use in acute situations
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Special
Features:
- Allows
visual evaluation of all airway passages
- Applicable
to all age groups
- Adaptable
with other airway devices/techniques
Tips for Success:
- Proper
topicalization of the awake/sedated patient
- "Jawthrust"
or use of oral/nasal airways or introducers
- Practice,
practice, practice!
Currently, devices are available from:
-
Olympus America, Inc.
- Pentax,
Inc.
- Karl
Storz, Inc.
References:
-
Benumof
JL. "Management of the Difficult Adult Airway, With Special
Emphasis on Awake Tracheal Intubation." Anesthesiology
75:1086, 1991.
-
Ovassapian
A. Fiberoptic Endoscopy and the Difficult Airway. 2nd
edition, Lippincott-Raven, Philadelphia, 1996.
-
Global
Anesthesiology Server Network
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