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The first AIME Advanced course was held in Halifax (January 30th, 2015).  Gene and I were both in attendance.  This is a demonstration done during that course.

Dr. Adam Law performs the airway topicalization on Dr. George Kovacs in preparation for an awake intubation. Dr. John Ross is filming the close ups that appear on the screens.


1. 5% lidocaine ointment

2. 10% lidocaine spray

3. 4% lidocaine atomized

From Gene:

I just wanted to add to some of what Mike has written.

First, I cannot say enough good about the AIME Advanced course. Even for their first time through, it was an incredibly polished product and extremely clinically relevant. Drs Kovacs, Law, and Ross not only have unbelievable amounts knowledge, but are great instructors.

Just a few points about what Dr. J Adam Law taught about oral anesthetization for awake intubation:

Before starting all of this, let the patient know they may lose their sensation of breathing as these structures will become anesthetized as the loss of this sensation can become anxiety producing to some patients. Have the patient breathe on their hand if they become troubled as this may help to quell anxiety. They will learn that they are still breathing!

Medication wise, start with two runs of 5-8cm of 4% lidocaine paste back and forth on the rear 1/3 “gag-o-genic” structures of the tongue

Use one spray of 10% lidocaine spray on each of the tonsillar pillars and one on the area of the soft-palate/uvula

Use multiple atomized 4% lidocaine sprays on the laryngeal structures. Note that a nebulizer is not the right choice as it creates so small of droplets that rain out in the lower airway and not the laryngeal area.


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