What is Awake Fibreoptic Intubation?

When you are asleep during an operation, a breathing tube is placed in the windpipe to support your breathing and maintain oxygenation to your body. Usually this tube is inserted after you are asleep.

Awake Fibreoptic Intubation (AFOI) is when a breathing tube is placed in the breathing passage through the nose or the mouth when you are awake.

When is Awake Fibreoptic Intubation done?

Placing a breathing tube in the breathing passage is an important part of an anaesthetic and in most cases this is done when the patient is asleep. In rare cases, this needs to be undertaken when the patient is awake for reasons of safety. These may include limited mouth opening, recent surgery or radiotherapy to the head and neck region or a large swelling, or because of the airway being challenging from clinical observations.

How will I know if I need Awake Fibreoptic Intubation?

You will be assessed by your anaesthetist. If your anaesthetist anticipates difficulty in placing the breathing tube, your anaesthetist may decide that it will be safer to place the breathing tube in your breathing passage, before putting you to sleep.

Your anaesthetist will discuss this with you in detail.

Will it be painful?

Local anaesthesia is given to ease off discomfort and make the procedure painless. Sedation is used to help you feel relaxed. Studies show that it is well tolerated by patients.

What to Expect during an Awake Fibreoptic Intubation?

In the anaesthetic room, you will be connected to a machine which monitors your heart rate, breathing and blood pressure. A cannula is placed at the back of your hand. You will be given a medicine which will give you a dry mouth and sedation to help you feel relaxed. The nose, mouth and the back of the throat is numbed with local anaesthetic by different techniques. This may be in the form of spraying or gargling and will be explained by your anaesthetist. The local anaesthetic is bitter to taste and will make you cough briefly. Your voice may become hoarse and it may be difficult to swallow. You will also be given Oxygen to breathe.

Once the airway is numbed, a fine camera loaded with the breathing tube is inserted through your nose or mouth into your windpipe.The breathing tube is passed into your airway and the camera is then removed. Anaesthetic drugs are given immediately  after this and you will go off to sleep.

After the procedure

The breathing tube is removed at the end of the operation. Your nose and throat may be numb. You may have a sore throat and a hoarse voice.  This can be expected after any anaesthetic. This will resolve naturally after a short time.

We advise you to wait a few hours before drinking and eating, especially items that may be hot in temperature, until the numbness from the local anaesthetic in the mouth wears off.

Patient Education Video

This video demonstrates what to expect during the Awake Fibreoptic Intubation procedure in a step by step manner.

If you have any further questions, please discuss them with your Anaesthetist.

Written by Dr Kausar Hirani and Dr Ajit Sukumaran.

Consultant Anaesthetists, North Manchester General Hospital.

Pennine Acute Hospitals NHS Trust.


Download this leaflet (printable version)

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