A Nontraditional Approach for Awake Fiberoptic Nasotracheal Intubation.

"an endotracheal tube (ET) is initially inserted into the nasal cavity, and then a flexible fiberoptic bronchoscope is introduced through it. The endotracheal tube will be connected to a catheter mount by which the investigator can deliver oxygenation. When using a nasal endotracheal tube, the tip is lubricated with 2% lignocaine jelly before being inserted into the nasal cavity and pushed up and down to allow the jelly to spread. The fiberoptic bronchoscope descends through the endotracheal tube after being inserted into the nasal passage as a nasal airway in the direction of the vocal cords until they can be seen.~After identifying the vocal cords, 2 ml of 2% lidocaine will be sprayed over the supraglottic area using the bronchoscope's working channel. An additional 2 ml of 2% lidocaine will then be sprayed directly onto the vocal cords, after which the tip of an endotracheal (ET) tube will be carefully inserted into them."

a 5.0-mm flexible fiberoptic bronchoscope (Pentax) will be loaded with an endotracheal tube of the proper size (7.5 for male and 7.0 for female patients). The bronchoscope tip will then be introduced into the nasal cavity, and the vocal cords will be detected.