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Awake Tracheal Intubation – A Demonstration

Video of awake tracheal intubation demonstration.
We’ve got that recording, so I’ll start this. OK. Over to you. I’m going to spray the back of your mouth as I told you. It’s going to taste of bananas and you may make you cough a bit. So open your mouth really big, as wide you can. Stick your tongue out. That’s great. Coming up now.
That’s it. Have a gargle with it. Ah.
Taste funny? Mm-hm. First one’s always the worst. Sorry.
OK, so we’re going to do the nose, as I said. I’m going to get you to take a deep breath out. Then sniff in when I say, OK? I’ll tell you when.
OK, so breathe out for me. And then all the way out. That’s it. And now sniff in through your nose. Sniff, sniff, sniff, sniff, sniff, sniff, sniff. Sniff.
Now breathe out. And then sniff all the way in for me. Sniff, sniff, sniff. That’s great Well done. Sorry. Tastes horrible, doesn’t it?
OK? Feeling funny in the back of your throat?
Mm-hm. It’s flavourful. You like it? Not very well! Open really wide as you can.
Now stick your tongue out at me. I’ll spray it and take a deep breath in. Breathe, breathe, breathe. That’s it. And gargle.
Bananas. Bananas? Yeah, bad bananas.
One more? One more. Open really wide. Stick your tongue out. Breathe out. And now deep breath in. Deep breath in. Breathe, breathe, breathe that’s great, well done.
That’s the worst of it, we’ll do a little bit more to make sure it’s all nice and numb. Yeah. You OK? Yeah.
You’ll start to get tingly and numb with each spray.
Yeah. So now it will be much more comfy. So open really wide. Stick your tongue out at me. All the way out. Some with your tongue out. that’s great.
OK, good. Have you done all the other sprays? Yeah, that’s it. MAD as well? Yeah. Great. So a couple more sprays, and then a yankauer and then we’re ready. Last bit of spray, sir, then we’re ready. You feeling a little more relaxed? Yeah. Perfect. Open big and wide.
Ah. Tongue out. Tongue out and breathe in.
Good, good. Numb. We’ll just get rid of some of your secretions, then we’re ready. All done. So I’m going to just– You can spit that out if you like. Yeah. Stick your tongue out for me. Stick your tongue out. That’s it.
Good. OK, i’m happy with that one. So now we look with the telescope.
Not all of it’s going in. Don’t worry. Right, so we’ll look through your nose. Dab it on the tongue first. Stick your tongue out for me.
And stick your tongue out. I’m just going to warm it on your tongue.
And that’s it. You can close your mouth and I’m going to look up the nose now.
Yeah, that’s it. keep going, along the floor.
OK sir, bit of pressure coming now. some pushing in the nose now. Just relax A little bit of pressure then we’ll ease off. It’s got gel on, yeah? It’s OK, don’t worry.
Well done. Well done. That’s it OK, hold the tube. Coming back out now, sir. Come back. Just come out and you’ll see. Yeah. And you’re at a nice length now. Lovely. Well done, sir. You were great. So we’re going to gently connect you up now. Finished.
Time to go to sleep now, sir. Well done. You OK? Yeah. All right. We’re going to take some deep breaths in and out through your nose for me. Deep breath. Perfect.

A patient at Guy’s and St Thomas’ hospital very kindly agreed to be filmed having an awake tracheal intubation and has allowed us to share it here. In the video you will see Dr Ed Roberts, senior anaesthetic registrar, safely and swiftly performing an awake tracheal intubation: safely intubating the trachea before anaesthetising the patient.

Take a moment to watch the video and compare Ed’s technique with your own, or other awake tracheal intubations that you have seen. How do they compare? What do you think went well in this demonstration?

In the next step we will review the recently published Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults that contain a lot of guidance and tips as to how to be successful with this technique.

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