Abstract
BackgroundThe Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade.Methods30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK) with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany) or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques.ResultsIn normal airway all intubations were successful using laryngoscope (100%) vs. 82% using the Bonfils (p < 0.05). In the scenario "tongue oedema" success rate using the Macintosh laryngoscope was 67% and 83% using the Bonfils. In the scenario "decreased cervical range of motion with jaw trismus", success rate using the Macintosh laryngoscope was 84% vs. 76%. In difficult airway scenarios time until airway was secured did not differ between the two devices. Use of Bonfils was rated "easier" in both difficult airway scenarios.ConclusionThe Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.
Highlights
The Bonfils intubation fibrescope is a promising alternative device for securing the airway
All 30 participants had performed a minimum of 100 endotracheal intubations each at the time of the investigation using the Macintosh laryngoscope
The duration of the intubation attempts using the Bonfils was longer compared to the Macintosh laryngoscope (p < 0.001)
Summary
The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009, 17:33 http://www.sjtrem.com/content/17/1/33 referred to as Macintosh blade) remains the so-called "gold standard" for endotracheal intubation [2]. In out-of hospital situations the use of an alternative device for endotracheal intubation is required by emergency physicians in 0.9 to 2.6% of all cases [4,5,6]. Supraglottic airway devices are generally accepted as alternatives in cases of failed endotracheal intubation. Endotracheal intubation has additional advantages and supraglottic airways may fail as well [7,8,9]
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