Comparison between fiberoptic bronchoscope versus C-MAC video-laryngoscope for awake intubation in obese patients with predicted difficult airway

Abstract

Background Airway care providers are familiar with video-laryngoscopes (VL) that have blades like that of traditional laryngoscope (Macintosh and Miller). Moreover, most of these providers have limited experience with fiberoptic bronchoscope (FOB). C-MAC VL is one of such VLs, and its D-blade was designed for anticipated difficult airway and airway management of obese patients. Aim The aim of this study was to assess the time required for awake intubation using C-MAC VL versus flexible FOB in morbidly obese patients with anticipated difficult airway assessed by El-Ganzouri simplified risk index. Patients and methods Sixty adult patients of both sexes were divided into two equal groups (30 patients each). In group FOB, awake patients were intubated using the flexible FOB. In group VL, awake patients were intubated using the C-MAC VL. Intubating time, laryngeal view, intubating attempts, heart rate, mean arterial pressure, oxygen saturation, and sore throat were recorded. Results Intubation time was significantly longer in FOB group compared with VL group. In VL group, 26 patients were intubated successfully on the first attempt, two patients on the second attempt, and two patients on the third attempt, whereas in FOB group, 22 patients were intubated successfully on the first attempt, six patients on the second attempt, and two patients on the third attempt. In FOB group, all patients had 100% percentage of glottic opening score. In VL group, 24 patients had 100% percentage of glottic opening score, four patients had 50–100% score, and two patients had less than 50%. The intubation success rate was 100% in both groups. There were no significant differences between both the groups at baseline and at first and fifth minute after intubation in hemodynamic parameters, CO2, and O2 saturation. Conclusion This study concluded that intubation time was shorter using C-MAC VL compared with flexible FOB for awake intubation of morbidly obese patients with anticipated difficult airway. However, flexible FOB provides excellent visualization of the glottic opening.