Abstract
BackgroundA variety of instruments are used to perform airway management by tracheal intubation. In this study, we compared the MacIntosh balde (MB) laryngoscope with the Bonfils intubation fibrescope as intubation techniques. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. Data were collected from 150 participants using an airway simulator [‘Laerdal Airway Management Trainer’ (Laerdal Medical AS, Stavanger, Norway)]. The participants were randomly assigned to a sequence of techniques to use. Four consecutive intubation ‘trials’ were performed with each technique. These trials were evaluated for differences in the following categories: the ‘time to successful ventilation‘, ‘success probability’ within 90 s,’time to visualisation’ of the vocal cords (glottis), and ‘quality of visualisation’ according to the Cormack and Lehane score (C&L, grade 1–4). The primary endpoint was the ‘time to successful ventilation‘in the fourth and final trial.ResultsThere was no statistically significant difference in the ‘time to successful ventilation’ between the two techniques in trial 4 (‘time to successful ventilation’: median: MB: 16 s, Bonfils: 14 s, p = 0.244). However, the ‘success probability’ within 90 s was higher when using a Macintosh blade than when using a Bonfils (95 vs. 87 %). The glottis could be better visualised when using a Bonfils (C&L score of 1 (best view): MB: 41 %, Bonfils: 93 %), but visualisation was achieved more rapidly when using a Macintosh blade (median: ‘time to visualisation’: MB: 6 s, Bonfils: 8 s, p = 0.003).ConclusionsThe time to ventilation using the MacIntosh blade and Bonfils mainly did to differ, however success probabilities and time to visualisation primary favoured the MacIntosh blade as intubation technique, although the Bonfils seem to have a steeper learning curve. The Bonfils is still a promising intubation technique and might be easier to learn as the MB, at least in a manikin.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-1937-2) contains supplementary material, which is available to authorized users.
Highlights
A variety of instruments are used to perform airway management by tracheal intubation
There was a tendency towards a higher ‘success probability’ for the subjects using an MacIntosh balde (MB) compared with those using a Bonfils (Table 2)
This study identified no significant difference in the ‘time to successful ventilation’ between the MB and Bonfils in the last of the four consecutive intubation trials performed on a simulator
Summary
A variety of instruments are used to perform airway management by tracheal intubation. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. The Bonfils rigid fibrescope, an airway instrument for tracheal intubation, was first described in 1983 [1], and it has been evaluated for elective [2, 3] and emergency intubation [4, 5]. Several learning curves have been described for the MB [18, 25], and success rates and speed of intubation mainly depend on the experience of the particular user [26]
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