Comparison of patients’ experience following awake and asleep fibreoptic intubation: A prospective observational study

Abstract

BackgroundAwake tracheal intubation using a flexible fibrescope is the safest technique to secure the airway in patients with predicted difficult airway. However, many anaesthetists are reluctant to perform this procedure due to the perception of causing the patient significant discomfort. The primary objective of this study was to assess whether there was considerable discomfort during awake nasal fibreoptic intubation compared to nasal fibreoptic intubation under general anaesthesia. The secondary objectives included patient-reported anxiety, distress, the feeling of the inability to breathe and postoperative sore throat. MethodsThe study was a prospective observational study conducted at two tertiary centres in the United Kingdom. Data from 130 patients (65 in the awake group and 65 in the asleep group) were analysed. ResultsThe number of patients who reported discomfort in the awake and asleep groups were 18 and 0 with a median (IQR [range]) of numerical rating scale score of 0 (0–3[0–10]) and 0 (0–0[0–2]) respectively (p < 0.001). The number of patients who reported distress and the feeling of the inability to breathe during awake intubation were 10 (15%) and seven (11%), respectively. There was no significant difference in anxiety or sore throat between the two groups. ConclusionAlthough there was a statistically significant difference in patient-reported discomfort and distress between the two groups, the numerical rating scale scores were low; therefore, awake fibreoptic intubation causes minimal discomfort or distress and anxiety.