Abstract
ObjectiveIn this study, we aimed to assess the feasibility of fiberoptic intubation (FOI), using a new, self-designed, “tongue root holder” device, in combination with the jaw thrust maneuver.MethodsThree hundred patients undergoing elective surgery requiring orotracheal intubation were enrolled. Patients presented at least one or more risk factors for difficult airway. The patients were randomly allocated at a 1:1 ratio to one of two groups: group L, FOI with tongue root holder, or group C, standard FOI. Orotracheal FOI was performed after commencement of anesthesia. The jaw thrust maneuver was applied in both groups to facilitate advancement of the fiberoptic bronchoscope. The primary endpoint was the feasibility of FOI. The secondary endpoints were number of attempts, time to intubation, and airway clearance at the soft palate and epiglottis levels.ResultsThe FOI was achieved in all 150 patients in group L, significantly higher than that in group C (100% vs 95.3%; P = 0.015). Less attempts of intubation were made in group L (P = 0.039). Mean time to successful intubation on the first attempt was shorter in group L (P < 0.001). The mean times to view the vocal cord and carina were also shorter in group L (P = 0.011 and P < 0.001, respectively). Airway clearance was better in group L at both the soft palate and the glottis levels (P = 0.010 and P = 0.038, respectively).ConclusionsThis study shows that FOI is feasible with the newly introduced, self-designed, “tongue root holder” device, when combined with the jaw thrust maneuver in patients with risk factors for difficult airway. The device also provides better airway clearance, less intubation attempts, and shorter time to intubation at first attempt.Clinical relevanceFiberoptic bronchoscope has been the gold standard for routine management of difficult airway. A technique to open the airway is introduced to reduce the incidence rate of upper airway obstruction.
Highlights
Difficult airway is one of the topics of greatest interest to anesthesiologists, as it remains an important cause for anesthesia-related morbidity and mortality
The fiberoptic intubation (FOI) was achieved in all 150 patients in group L and in 143/150 patients in group C
Intubation success rate on the first attempt differed between the groups
Summary
Difficult airway is one of the topics of greatest interest to anesthesiologists, as it remains an important cause for anesthesia-related morbidity and mortality. Xiaofei Cao and Junbei Wu contributed to this work. Every anesthesiologist should make her- or himself master of this technique and use it on a daily basis. When advancing fiberoptic bronchoscope, we might meet difficulties. Muscle tone is reduced and soft tissues might displace closer to the posterior pharynx.
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