Podcast 594: Topicalization for Awake Intubations

<p><strong>Contributor: Ricky Dhaliwal, MD, JD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">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</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">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.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Good topicalization can be confirmed by testing for lack of a gag reflex</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Simmons ST, Schleich AR.</span> <a href="https://pubmed.ncbi.nlm.nih.gov/11915066/"><span style= "font-weight: 400;">Airway regional anesthesia for awake fiberoptic intubation.</span></a> <em><span style="font-weight: 400;">Reg Anesth Pain Med</span></em><span style="font-weight: 400;">. 2002;27(2):180-192. doi:10.1053/rapm.2002.30659</span></p> <p><span style="font-weight: 400;">Ducharme J, Matheson K.</span> <a href="https://pubmed.ncbi.nlm.nih.gov/14583715/"><span style= "font-weight: 400;">What is the best topical anesthetic for nasogastric insertion? A comparison of lidocaine gel, lidocaine spray, and atomized cocaine.</span></a> <em><span style= "font-weight: 400;">J Emerg Nurs</span></em><span style= "font-weight: 400;">. 2003;29(5):427-430. doi:10.1016/s0099-1767(03)00295-2</span></p> <p> </p> <p><em><span style="font-weight: 400;">Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p> </p> <p><br /> <br /></p> <div id="highlighter--hover-tools" style="display: none;"> <div id="highlighter--hover-tools--container"> <div class="highlighter--icon highlighter--icon-copy" title="Copy">  </div> <div class="highlighter--se