Awake Tracheal Intubation

CA-3 · I.B.3.c.2 II.C.1.d.1.f.13 I.B.6.a.1

25Sources
6Kept
1Dropped

1 · Find evidence

PubMed query

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25 candidate papers

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Same-day build

PubMed query

Runs the tiered searches, drafts one point per included paper, runs the citation gate and builds a draft deck — the steps below, unattended. Same-day build — drafted locally (medgemma:27b), confirmed against each abstract. The deck still lands in draft: nothing here approves anything.

2 · Teaching points

Source

A point with no source will not survive the gate. That is the point of the gate.

7 points

Awake tracheal intubation halved in frequency between 2014 and 2020, and in this single-centre cohort first-attempt success was higher with flexible bronchoscopy than videolaryngoscopy (84% versus 60%) — pooled randomised trials found no such difference. PMID 36289151 — not confirmed against the abstract: The abstract states ATI use decreased by about 50%, not halved, and mentions the comparison between flexible bronchoscopy and video laryngoscopy success rates but does not mention pooled randomized trials. dropped
Guidelines on awake tracheal intubation agree on the procedure itself and on confirming tube position, but conflict on indications and airway local anaesthesia, and only 3 of 7 were rated high quality. PMID 39966725 kept
Awake intubation was used in about 1% of general anaesthetics and that rate did not fall over 12 years despite a large rise in videolaryngoscopy, with 2% of attempts failing. PMID 25907462 kept
Videolaryngoscopy likely reduces rates of failed intubation compared to direct laryngoscopy (Macintosh-style RR=0.41, hyperangulated RR=0.51, channelled RR=0.43). PMID 35820934 kept
Awake intubation took a median of 24 minutes from entering theatre against 16 minutes for intubation after induction, with a 1% failure rate and 1.6% complications — it costs time, not safety. PMID 27111535 kept
For awake tracheal intubation, videolaryngoscopy shortened intubation time compared with flexible bronchoscopy and slightly reduced desaturation below 90%, with no difference in failure or first-attempt success. PMID 38892899 kept
Optical stylets result in the shortest time to tracheal intubation compared to flexible bronchoscopes and videolaryngoscopes during awake tracheal intubation. PMID 34303493 kept

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5 · Question bank

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