Podcast 594: Topicalization for Awake Intubations

Contributor: Ricky Dhaliwal, MD, JD

Educational Pearls:

• Topical anesthetization can allow for an awake intubation, which substantially decreases chance of loss of airway or respiratory drive because sedatives/paralytics are not necessary
• Lidocaine treatments like URO-JET (2% lidocaine jelly) can be applied through the nare followed by LMX cream (4% lidocaine) which should be applied to the back of the tongue to anesthetize the tongue and larynx.
• Good topicalization can be confirmed by testing for lack of a gag reflex

References

Simmons ST, Schleich AR. Airway regional anesthesia for awake fiberoptic intubation. Reg Anesth Pain Med. 2002;27(2):180-192. doi:10.1053/rapm.2002.30659

Ducharme J, Matheson K. What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine. J Emerg Nurs. 2003;29(5):427-430. doi:10.1016/s0099-1767(03)00295-2

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD