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Gas Cookbook is a quick reference for UK healthcare professionals. Recipes are example plans and calculators reproduce published formulas; check every dose against the BNF and your local protocols and adapt to the patient in front of you. Our liability is limited as set out in the Terms; nothing excludes liability that cannot be excluded by law. Read the full disclaimer.

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Gas Cookbook | Awake Tracheal Intubation: Fibreoptic Scope

Awake Tracheal Intubation: Fibreoptic Scope

Awake Tracheal Intubation: Fibreoptic Scope

Sedation · 30 min

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

Details

Specialty: Other
Author: Gas Cookbook
Airway: ETT
Procedure: Awake Fibreoptic Intubation
Updated: Jun 2026

Example plan written by a clinician, not medical advice. Check every dose against the BNF and your local protocols and adapt to the patient in front of you. You remain responsible for every clinical decision. Disclaimer · Report an error

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