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This collection of recipes is intended for educational purposes only. Users should adapt these recipes based on individual patient requirements, clinical judgment, and adherence to local and national guidelines.

We cannot be held liable for any adverse outcomes or issues arising from the use or application of these recipes.

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Gas Cookbook | Awake Tracheal Intubation: Fibreoptic Scope

Awake Tracheal Intubation: Fibreoptic Scope

Notes Oxygenation Topicalisation Sedation Procedure Topicalisation Dosage

Other

Awake Tracheal Intubation: Fibreoptic Scope

SedationDuration30 minutesUpdatedJun 2026

Notes Oxygenation Topicalisation Sedation Procedure Topicalisation Dosage

Numerous online guides are available for awake tracheal intubations, including detailed breakdowns of specific equipment and techniques.
Further information can be found at AAGBI and DAS

ProcedureHigh Flow Nasal OxygenationOptiflow, 30-70l/min
Continue HFNO throughout procedure

Max lidocaine dose: 9mg/kg LBW

co-phenylcaine125mg spray to turbinates of selected nostril
2% lidocaine5ml, 100mg via MAD in selected nostril
10% lidocaine10x sprays, 100mg via atomiser to oropharynx
2% lidocaine5ml, 100mg in 5ml syringe via MADgic atomiser x1-2
Check for successful topicalisation with suction catheter
Optional Final topicalisation when vocal cords directly in view of scope

Reassure patient throughout each step of procedure
Encourage gargling and swallowing of local anaesthetic, instead of spitting

Sedation if required - delivered by 2nd anaesthetist
RemifentanilTCI, Cet 1-2

(3+1) attempts
Anaesthesia induced only after two-point check of tracheal tube position (visual confirmation + capnography)
Propofol150-200mg
Optional Fentanyl100mcg

NEO Airway Topicalisation - Male
NEO Airway Topicalisation Chart - Female

For reference only. Always check doses against the BNF and your local protocols, and adapt to the patient in front of you. Gas Cookbook is community-shared guidance, not medical advice; clinical responsibility stays with you.

Airway

ETT

Procedure

Awake Fibreoptic Intubation

By Jeremy Chui