Information for patients
needing an awake fibre optic intubation
What is it?
During general anaesthesia for surgery, you need to have a small breathing tube placed into
your windpipe when you are asleep. This is known as ‘intubation’.
This tube is used to help you with your breathing while you are asleep under general
anaesthesia.
Although this placement of the tube or intubation is usually done when you are asleep, in a
small number of patients, it is safer to insert this tube while you are awake. This procedure is
done under local anaesthetic using a flexible camera and is called an ‘awake fibre optic
intubation’.
Why do I need it?
The only reason for having an ‘awake fibre optic intubation’ is that your condition makes it
unsafe for you to have a general anaesthetic before the breathing tube is in place.
When you breathe oxygen from the atmosphere into your lungs, it must pass through your
mouth or nose and into your windpipe. This route is called your ‘airway’. We are all different
shapes and sizes and some people are born with ‘difficult airways’ which are prone to blocking
during anaesthesia.
You may need this if you are having a general anaesthetic and have the following conditions:
An abnormal growth or lump in the mouth, throat or neck.
Reduced mouth opening or jaw problems.
Neck problems such as fracture of the bones in the neck.
Swelling of your mouth, throat or neck because of infection.
How is it done?
We use local anaesthetic to numb you from the nose, along the back of the throat to the
windpipe. We may also give you a sedative to make you feel sleepy and relaxed.
When you are comfortable and your mouth and throat are numb, we will pass the breathing tube
into the windpipe. We do this with the help of a fibre optic camera which is a small flexible
camera. This enables us to see down your throat and into your windpipe. As soon as the
breathing tube is safely secured, you will have your general anaesthetic in the normal way.
Will it be painful or uncomfortable?
In the vast majority of cases, there may be some discomfort but no pain.
Your anaesthetist will do everything to ensure that you are not only kept safe, but as
comfortable as possible. This usually includes giving you medicines to sedate you during your
intubation and local anaesthetic medicine to make all the affected areas numb.
What can I expect?
Once in the anaesthetic room, you will be connected to a machine to monitor your heart,
breathing and blood pressure. A drip will be inserted and your anaesthetist may give you a
strong sedating medicine. You may also receive a medicine to reduce saliva production, which
may result in you having a dry mouth after your operation.
Local anaesthetic medicine will be sprayed into your nose and mouth which makes everything
numb. You may find that this bit makes you cough temporarily.
When the airway is numb, your anaesthetist will insert the flexible fibre optic camera into either
your nose or mouth and guide it towards your windpipe. Once the tube is guided into the
windpipe, you may feel the need to cough. Your anaesthetist will then administer a general
anaesthetic and you will go to sleep for the operation.
What are the risks and alternatives to an ‘awake fibre optic intubation’?
There are no additional risks with this ‘awake’ method of introducing the breathing tube and for
those patients ‘with difficult airways’. There is no safer alternative to this procedure.
After your operation
When you wake up, your mouth, tongue and throat will feel numb for a few hours, so there may
be a short delay before you can eat or drink again. After you wake up, it is possible that you
may experience a sore throat, but this should settle very quickly
Further information
If you would like to ask any questions or discuss things in more detail, then your anaesthetist
will be available to talk to you before your operation.
Reference Code: P1830/1681/06.2015/VERSION1
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