Postoperative Complications, Patient Safety, and Comfort of the Oral Fiberoptic Bronchoscopy-guided Intubation Compared with the Oral laryngoscope Intubation

Abstract

Introduction: Postoperative sore throat (POST) and hoarseness is an on-going worldwide challenge after general anaesthesia. In this study, we hypothesised that patients intubated with the fiberoptic bronchoscope–guided intubation device differs in POST and hoarseness from other patients intubated with the oral Macintosh laryngoscope–guided intubation device. If this could be confirmed, the guideline of peri anaesthesia may need to be different. Objective: This study aimed to investigate whether fiberoptic intubation can provide increased patient safety and comfort compared to standard laryngoscope intubation performed by nurse anaesthetists. Methods: Within this single-blinded, consecutively controlled clinical trial two hundred and nine patients scheduled for elective neurosurgical treatment requiring intratracheal intubation, were randomly divided into intervention and control group. The intervention group received fiberoptic bronchoscopy–guided intubation during anaesthesia as well as nursing and postoperative treatment based on conventional drug therapy after neurosurgical treatment. The control group received intubation during anaesthesia, as usual, using Macintosh laryngoscope intubation, and postoperative treatment based on conventional drug therapy after neurosurgical treatment. Data regarding the patient safety were obtained during peri anaesthesia, and data concerning the patient comfort were collected on the first postoperative day. Statistical analyses were performed using SPSS version 22. Results: Seven patients were excluded (3.3%); thus, the final population consisted of two hundred and two patients: 62.4% women, the mean age of 52 years (20 to 86 years), 106 (52.5%) patients in the fiberoptic intubation group. A statistically significant difference was found between groups according to patient safety, measured by the number of anaesthetists involved P=0.024 in favour of the fiberoptic intubation device. A trend was pointing to increased pain in the mouth and throat P=0.053, when intubated with the laryngoscope. Other patient safety and comfort measurements showed no statistically significant differences between groups. Conclusions: The study directs attention to some possible benefits of using the fiberoptic intubation device, which may improve patient safety and comfort when compared to standard laryngoscope intubation.