ABSTRACT
Fiberoptic intubation with the patient in the sitting position is the usual approach. The patients are pretreated with glycopyrrolate 0.4-0.8mg. The airway is anesthetized with aerosolized 4% lidocaine, cetacaine spray, or viscous lidocaine. Small amounts of sedation may be used (1mg increments of midazolam), but should not be substituted for good topical anesthesia. Opioids are avoided. Low flow (2-4 L/ min) oxygen can be administered through the suction port of the fiberoptic scope. This helps oxygenate the patient, and propels secretions away from the lens. However, care must be taken that the flow rates are not high enough to force gas into the stomach or to dissect the pharyngeal mucosa. In the absence of tumor or other lesions distorting the anatomy, fiberoptic intubation is usually rapidly accomplished. It is best if the anesthesiologist and surgeon discuss and agree on the airway approach, especially the alternatives to the original plan.
