Bonfils Fiberscope: Better Preoxygenate Rather than Oxygenate!

Abstract

To the Editor: Hemmerling and Bracco1 describe subcutaneous emphysema developing during use of a Bonfils fiberscope through which oxygen at a flow of 10 L/min was being used during tracheal intubation. They conclude that the problem was due to the excessive oxygen flow and comment that they have changed their practice reducing the oxygen flow to 6 L/min while using the Bonfils device. We suggest that even 6 L/min flow through the Bonfils is excessive and that the most effective maneuver for prolonging the apneic period during airway manoeuvers is preoxygenation using a high fresh gas flow and a properly applied face mask, as recommended in Difficult Airway guidelines2 or in other papers regarding Bonfils fiberscope clinical use.3 The oxygen port on the Bonfils is not intended to prolong the apneic period during tracheal intubation,1 and the risk of barotrauma might be increased (especially with large endotracheal tubes) as the tip of the tube impacts upon the larynx. For this reason the manufacturer suggests an oxygen flow of no more than 3 L/min. Dr. Hemmerling did not send a response. Massimiliano Sorbello, MD Annalaura Paratore, MD Gianluigi Morello, MD AOU Policlinico Università di Catania (Italy) [email protected] Guido Merli, MD Centro Cardiologico Monzino Milano, Italy Angela Antonietta Belluoccio, MD Flavia PetriniMD, PhD Università di Chieti—Pescara (Italy)