Nasal versus oral fiberoptic intubation via a cuffed oropharyngeal airway (COPA™) during spontaneous ventilation

Abstract

Study objective To compare the success rate of nasal versus oral fiberoptic intubation in anesthetized patients breathing spontaneously via the cuffed oropharyngeal airway (COPA™). Design Prospective, randomized, controlled study. Setting Two university-affiliated hospitals. Patients Patients scheduled for general or plastic surgery of the torso or extremities. Interventions Nasal (n = 20) and oral (n = 20) fiberoptic intubation were performed in patients while breathing spontaneously via the COPA™ during standardized anesthesia. Measurements Demographic data, mean arterial pressure, heart rate, end-tidal carbon dioxide (ETCO 2), oxygen saturation (SpO 2), COPA™ size, difficult airway predictors, rate of failed ventilation via COPA™, and frequency of hypoxemia (SpO 2 < 90%) during the procedure, and perioperative untoward events were recorded. Main results The background, airway difficulty, vital signs and untoward effects were similar in the two groups. Nasal fiberoptic laryngeal view (scale 1–4) was better than the oral grading (3 [median] vs. 2, respectively; p < 0.05). Eighty percent of the nasal intubations were successful compared with 40% of the oral intubations ( p < 0.05). Nasal intubations were accomplished within 153 ± 15 SD seconds compared with 236 ± 22 seconds ( p < 0.05) for the oral intubations, and less propofol was needed in the nasal intubations during the procedures (240 ± 27 mg [nasal] vs. 277± 39 mg [oral]; p < 0.05). Conclusions Nasal fiberoptic laryngoscopy is more successful and easy than the oral approach in anesthetized patients who are breathing spontaneously through the COPA™.