Fiberoptic Bronchoscopy-guided Awake Nasotracheal Intubation for Airway Management of Patients with Deep Neck Infection Undergoing General Anesthesia

Abstract

Deep neck infections pose significant challenges for airway management due to swelling of soft tissues, formation of abscesses, and limited jaw and neck movement, which increase the risk of serious airway obstruction. Administering general anesthesia in such cases can worsen airway obstruction, making awake intubation the method of choice. Using fiberoptic bronchoscopy for awake nasotracheal intubation provides airway security while allowing spontaneous breathing, thus minimizing the risk of total airway blockage. This review covers the pathophysiology of airway compromise associated with deep neck infections, the indications and contraindications for awake intubation, and the vital techniques for executing fiberoptic bronchoscopy-guided awake nasotracheal intubation. Key procedural steps include careful patient monitoring, oxygenation, premedication, topical anesthesia, and sedation to ensure a successful procedure. Technically, a tracheal tube is maneuvered into the tracheal lumen over the fiberoptic bronchoscope's insertion cord, which is previously placed within the trachea. When done correctly, this approach enhances patient safety by avoiding airway collapse and ensuring controlled airway access during the induction of general anesthesia. Fiberoptic bronchoscopy-guided awake intubation remains essential in managing difficult airways in patients with deep neck infections undergoing general anesthesia.