Bonfils Fiberscope Research Articles

Awake intubation with the use of bonfils fiberscope in patients undergoing non-cardiac surgery: Case series

Awake intubation with the use of bonfils fiberscope in patients undergoing non-cardiac surgery: Case series

Awake fiberoptic intubation with double lumen tube for severe predicted difficult airways: Could it be feasible with a rigid fiberoptic stylet?

Awake fiberoptic intubation with double lumen tube for severe predicted difficult airways: Could it be feasible with a rigid fiberoptic stylet?

Airway management in morbidly obese adolescents

Background and aim Pediatric patients presenting to bariatric surgery is increasing in percentage in the last years and has become a fast growing epidemic problem. The aim of this study was to evaluate the usefulness of Bonfils fiberscope (BF-L) and fiberoptic bronchoscope (FO-L), assisted by direct laryngoscopy for intubation in morbidly obese adolescents with predicted easy intubation using the El-Ganzouri risk index score. Patients and methods Thirty adolescent American Society of Anesthesiologist II–III patients, aged 12–19 years, scheduled for laparoscopic bariatric surgery were randomized into two equal groups for intubation, with assistance of regular Mackintosh laryngoscope in both groups, either group BF-L and group FO-L. The standard protocol for general anesthesia was used for both groups. The primary outcome measure was the visualization quality using the percentage of glottis opening score. The secondary outcome measures were: duration of intubation and number of intubation attempts. Results Percentage of glottis opening scores were significantly better in group BF-L, when compared with group FO-L (93±6.44%/83±8%, respectively, P=0.002). The intubation success rate was 100% in both groups, and the mean intubation time was significantly longer (16±4.67 s) in group FO-L compared with 11±3.50 s in group BF-L (P=0.02). As regards the number of attempts, all patients were successfully intubated on the first attempt in group BF-L, while intubation was successful in 14 patients in group FO-L and one patient on the second attempt, which was statistically insignificant (P<0.05). Conclusion Orotracheal intubation was performed more rapidly and easily with BF-L and FO-L, with superiority of BF-L than FO-L in patients with predicted easy intubation using the El-Ganzouri risk index score

Hemodynamic responses to tracheal intubation with Bonfils compared to C-MAC videolaryngoscope: a randomized trial

BackgroundDirect laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury. Bonfils fiberscope and C-MAC videolaryngoscope are associated with little hemodynamic instability compared to DL. Scientific evidence comparing these two alternatives does not exist. We conducted this study to determine the hemodynamic effects of Bonfils compared to C-MAC in patients undergoing elective surgery.MethodsFifty (50) patients listed for elective surgery were randomly assigned to endotracheal intubation with Bonfils or C-MAC. After a standardized induction, intubation was done via the retromolar approach (Bonfils group) or via videolaryngoscopy (C-MAC group). A research assistant, who was not blinded to the intervention, recorded heart rate (HR) and arterial blood pressure (systolic, diastolic and mean arterial blood pressure [MAP]) at induction and at every minute during the 5 min post intubation. The primary outcome was the hemodynamic response to intubation, as verified every minute for the first 5 min compared to baseline value.ResultsAfter randomization, the two groups were comparable except for ASA I/II ratio which was slightly higher in the C-MAC group (p = 0.046). Heart rate (p = 0.40) and MAP (p = 0.30) were comparable between the two groups within 5 min post intubation. Intubation time was shorter with C-MAC than with Bonfils (30 ± 2 s vs 38 ± 2 s; p = 0.02).ConclusionHemodynamic responses to tracheal intubation using the Bonfils fiberscope is comparable to the C-MAC videolaryngoscope among patients scheduled for an elective surgery. In light of these findings, using either technique appears to be a reasonable course of action.Trial registrationISRCTN #34923, retrospectively registered, 26/03/2018.

Difficult airway intubation simulation using Bonfils fiberscope and rigid fiberscope for surgical training

IntroductionPediatric otolaryngologists are frequently called to assist in difficult airway management in newborns with Pierre Robin Sequence (PRS) who have microretrognathia, glossoptosis, and an anterior larynx. The Bonfils fiberscope (BF) is a curved rigid scope designed to provide superior visualization in the anterior larynx. Objective(1) to assess whether BF provides an improvement in intubation success rate, time to intubation, or airway visualization as compared to rigid fiberscope (RF) in a difficult airway simulation setting and (2) to determine whether a training program for BF can improve time to intubation through practice trials. MethodsSix right-handed trainees completed five trials on each of the three following airway models using the BF and RF: normal anatomy, anterior larynx and PRS. The normal larynx model was intubated only with RF. Main outcome measures were the time needed for tracheal intubation and Cormack–Lehane classification (1–4). ResultsThe majority of the intubation trials showed a statistically significant difference between first and last completion times (p < .05) suggesting construct validity. Only the anterior larynx trials with BF did not demonstrate an improvement in time to intubation between first and last attempts (p < .3125). For the PRS retrognathia model, there was no statistically significant difference in time to intubation between using the BF and the RF (p < .44); in the anterior larynx model, the RF yielded a faster time to intubation than the BF on the final trial attempts (p < .0313). By Cormack–Lehane classification measures, laryngeal visualization by the BF was better than RF in the PRS manikin (p < .0022) while there was no significant difference in grade scores for the anterior larynx manikin (p < .45). All six trainees reported an improved visualization of the larynx with the BF compared to the RF for both the anterior larynx and PRS manikins; at the end of the trial runs, all participants noted an improvement in comfort level using the BF. ConclusionThe difficult airway simulation model is feasible for surgical training. BF adds superior visualization of the anterior larynx in PRS. Otolaryngology training programs may include BF as a supplemental tool in addition to RF as a part of the airway equipment training since there is significant improvement in time to intubation with consecutive practice trials and superior laryngeal visualization.

Comparison of success of tracheal intubation using Macintosh laryngoscope-assisted Bonfils fiberscope and Truview video laryngoscope in simulated difficult airway

Background and Aims:Restriction of head and neck movements prevents the alignment of the oral, pharyngeal, and laryngeal axes and increases the incidence of difficult tracheal intubation in patients with cervical spine fractures. Video laryngoscopes have gained an important role in the management of difficult intubation, especially in situations with limited head and neck movements. This study compares the success of intubation using Macintosh laryngoscope assisted Bonfils® fiberscope (ML-BF) with TruviewPCD video laryngoscope (TV) in patients with simulated restricted head and neck movements.Material and Methods:One hundred and fifty-two patients satisfying the inclusion criteria were randomly allocated to two groups of 76 each. Patients were made to lie supine on the table without a pillow and a soft collar was used to restrict head and neck movements. After a standardized premedication-induction sequence, tracheal intubation was done either with ML-BF or TV. Success of intubation, time taken for successful intubation, hemodynamic changes, airway trauma, and postoperative oropharyngeal morbidity were noted.Results:Intubation was successful in all the 76 patients in direct laryngoscopy-Bonfils fiberscope group and 75 out of 76 patients in TV group within the specified time (90 s). The median time taken for successful intubation with TV and ML-BF were 44 (range 26–80) s and 49 (range 28–83) s, respectively. Hemodynamic changes, airway trauma, and postoperative oropharyngeal morbidity were similar in both groups.Conclusion:Both TV and ML-BF are equally effective for successful tracheal intubation in patients with simulated restricted head and neck movements. In cases of difficult laryngeal visualization with routine Macintosh laryngoscope, Bonfils can be used as an adjunct to achieve successful intubation in the same laryngoscopy attempt.

Bonfils fiberscope vs GlideScope for awake intubation in morbidly obese patients with expected difficult airways

Study ObjectiveTo assess the efficacy of both Bonfils and GlideScope in obese patient with difficult airways for bariatric surgery using awake intubation. DesignComparative study. SettingOperating room. PatientsThe study was carried out on 60 patients, for laparoscopic bariatric surgery, after approval of the Medical Ethics Committee and having an informed written consent from each patient. Patients were randomly categorized into 2 equal groups 30 patients in each group. InterventionsAwake intubation with either Retromolar Bonfils or GlideScope. MeasurementsTime to visualize the laryngeal inlet, time of intubation, time of scope manipulation, success rate at each attempt, the lowest oxygen saturation, hemodynamic parameters, and any complication. Main ResultsRegarding intubation criteria, GlideScope achieves shorter times compared with Retromolar for visualization of the vocal cords and intubation, in addition to less intubation attempts, but both without a statistically significant difference. Retromolar shows better patient satisfaction than does GlideScope, with statistically significant difference. ConclusionsBoth Bonfils fiberscope and the GlideScope can be successfully used for awake intubation in morbidly obese patients with expected difficult airways. Bonfils intubating fiberscope was more tolerated by patients with statistical difference; on the other hand, GlideScope provided shorter intubation time and less intubation attempts but not statistically significant.

Hemodynamic responses to endotracheal intubation: A comparison between Bonfils intubation fiberscope and direct laryngoscopy

Background: Laryngoscopy and intubation are intensely stimulating procedures and can induce marked sympathetic responses. We hypothesized that by minimizing the oropharyngeal stimulus with Bonfils rigid fiberscope intubation, the hemodynamic responses to endotracheal intubation will be lesser. Therefore, we compared Bonfils intubation with conventional direct laryngoscopic intubation in adult patients with normal airway. Materials and Methods: Sixty adult patients of either sex, belonging to American Society of Anesthesiologists grade 1 or 2, were randomized into Bonfils group and laryngoscopy group, and studied over a 2-year period. Anesthet ic technique was standardized in both the groups. Hemodynamic variables were recorded at pre-induction, induction, post-induction at laryngoscopy and intubation, thereafter for every minute for 10 min, and half hourly till the end of surgery for both the groups. Intubation time, intubation attempts, and postoperative complications like hoarse voice and sore throat were compared between the two groups. Results: There was no statistically significant difference between the two groups with respect to systolic blood pressure, mean blood pressure, and heart rate changes throughout the study period. There was a statistically significant difference in the diastolic blood pressure (DBP) values between the groups (P < 0.05) for the first 10 min following intubation. The time required for intubation was significantly longer in the Bonfils group (36 ± 6 s) compared to the laryngoscopy group (28 ± 6 s) (P = 0.000). The incidence of postoperative sore throat (P = 0.009) and hoarseness of voice (P = 0.045) was significantly lesser in the Bonfils group compared to the laryngoscopy group. Conclusion: There was no clinically significant difference in the hemodynamic changes following intubation using either Bonfils fiberscope or conventional laryngoscope. Bonfils intubation required longer time, but was associated with lesser incidence of sore throat and hoarseness of voice when compared to laryngoscopic intubation.

A randomized controlled comparison of the Bonfils fiberscope and the GlideScope Cobalt AVL video laryngoscope for visualization of the larynx and intubation of the trachea in infants and small children with normal airways

The Bonfils fiberscope (BF) used without the assistance of a laryngoscope failed to improve the view of direct laryngoscopy in children with normal airways. We hypothesized that if BF is supported by a laryngoscope--as recommended by its inventor--it can provide comparably good visualization of the glottis as the GlideScope(®) Cobalt AVL video laryngoscope (GS). We included 100 children with normal airways in a randomized controlled trial. The study consisted of assessing the airway by direct laryngoscopy (DL), followed by intubation using either the BF or the GlideScope. Main outcome measures were the quality of visualization of the larynx by the percentage of glottis opening seen (POGO) and the time needed for intubation of the trachea. Visualization of the larynx (POGO) using the BF was significantly better than with DL (P = 0.016) or with GS (P = 0.001). The DL provided an allover better visualization than GS, although this difference was not significant and solely attributable to children weighing <15 kg. Intubation was successful in all cases with both devices. The time needed for intubation was shorter using the BF (36 ± 8 s) than with the GlideScope (49 ± 12 s, P < 0.001). The Bonfils fiberscope significantly improved the view on the larynx compared with direct laryngoscopy and the GlideScope and enables shorter intubation time than with the GlideScope.

Macintosh laryngoscope versus Bonfils Intubation Endoscopes in endotracheal intubation: Hemodynamic, intra-ocular pressure and serum catecholamine responses

ObjectiveOne of the alternative methods in managing patients for endo-tracheal intubation is the Bonfils fiberscope. We studied the efficacy of Bonfils fiberscope in comparison to the classical laryngoscope with Macintosh blade inhemodynamic, serum catecholamine and intra-ocular pressure responses.MethodsIn a prospective, randomized trial 40 patients ASA I or II aged ⩾18 years scheduled for gynecological, urinary and lower abdominal procedures in supine position were randomly allocated to one of two groups; 20 patients each; according to intubating device by using either Macintosh laryngoscope (L) group or Bonfils Intubation Endoscopes (B) group. Pre-induction (baseline) and pre-insertion values of HR, MAP, IOP and blood samples for catecholamine level were recorded and repeated at 1, 3, and 5 min after intubation.ResultsThere was significant increase in HR, MAP, IOP and catecholamine level in L group at 1, 3, and 5 min after intubation.ConclusionBonfils laryngoscope had superiority over Macintosh as a method of intubation in situations where minimal changes in hemodynamic, catecholamine level and intraocular pressure are desirable.

Intubation Using a “Bonfils Fiberscope” in a Patient With Pfeiffer Syndrome

To the Editor: Pfeiffer syndrome is an autosomal dominant disorder characterized by craniosynostosis, brachicephaly, midface hypoplasia, low nasal bridge, flat occiput, severe ocular proptosis, over-sized tongue, and cerebral ventriculomegaly (Fig. 1).1FIGURE 1: A, Computed tomography scan reconstruction of the skull. B, The operator practices the intubation on a mannequin performing upward traction of the mandible by holding it between the left hand thumb and the forefinger.Providing general anesthesia in such patients could lead to complications in terms of airway management, due to potential difficulties in ventilation using the facial mask or tracheal intubation.2 A Bonfils fiberscope is a handy device to overcome difficulties of intubation, both in pediatric patients and in neonates. It is a rigid telescopic stylet with a 40-degree curved tip, which is inserted inside the endotracheal tube, keeping its distal end positioned just proximal to tip of the tube. The proximal eyepiece end of the device allows connections for a video monitor and a fixed or battery-operated light source. The instrument can be easily locked onto an endotracheal tube, while a special connector allows administration of the gases during intubation.3–4 The instrument is available in various sizes and its design makes intubation easy under direct visualization. The main limiting factor for its use is the rigidity, which may increase the risk of airway trauma. Obviously, it cannot be used for nasal intubation. We encountered the case of a 6-year-old patient, weighing 21 kg, who had Pfeiffer and Arnold Chiari syndromes, with caudal migration of cerebral tonsils to the level of the second cervical vertebra. Due to the presence of loud snoring and oxygen desaturation during sleep, the patient was required to undergo adenoidectomy under general anesthesia. The endotracheal intubation was found to be very challenging in this particular case. The induction was carried out with an intravenous administration of fentanyl 60 mcg and propofol 60 mg. At this stage, the anesthesiologist performed upward traction of the patient’s mandible by holding it between the left hand thumb and the forefinger (Fig. 1B) without using the laryngoscope. The Bonfils fiberscope, held in the right hand, was inserted through the oral cavity, the scope preloaded with size 5.5 mm, and the intubation was performed without any difficulty. Our case illustrates that the Bonfils fiberscope allows easy intubation in cases with a complicated upper airway anatomy without requiring a laryngoscope. Some authors do believe, however, that the use of a laryngoscope may be necessary when the Bonfils fiberscope is used in adult patients.5 We recommend that the operator practice the intubation on a mannequin, according to the aforementioned method before the actual procedure. In summary, we find the rigid Bonfils fiberscope a useful device for difficult intubation in pediatric patients with a complex upper airway anatomy. We recommend that this instrument be made available in operatory rooms where pediatric patients undergo general anesthesia. Marco Caruselli, MD Roberto Giretti Roberta Pallotto Giovanni Rocchi Anesthesia and Intensive Care Unit, “Salesi” Children’s Hospital, Ancona Laura Carboni Anesthesia and Intensive Care Unit, “Burlo Garofolo” Children’s Hospital, Trieste, Italy

Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope™ with a novel modification

BackgroundThe Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.MethodsTwenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.ResultsParticipants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).ConclusionsWith this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.

A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study

Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate. A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult. The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.

Emergency airway management using the Bonfils intubation fiberscope

The difficult airway is a challenge to both the emergency physician and the anesthesiologist. Its incidence in the Emergency Department (ED) is understandably higher as there is a disproportionately larger number of patients requiring airway management as a result of acute medical or surgical conditions, which by themselves contribute to the difficulty and because the patients are not prepared for intubation as during elective surgery [1]. Many videobased intubation devices have been developed as an alternative to flexible fiberoptic bronchoscope intubation and direct laryngoscopy for difficult airway management and various rigid fiberoptic stylets have been proposed [2], including the Bonfils retromolar intubation fiberscope, a recently re-discovered airway device designed in the 1980s (Karl Storz Co., GmbH, Tuttlingen, Germany) (Fig. 1, 2). It is a reusable, rigid, straight fiberoptic device with a 40 curved tip, 40 cm long and 5 mm in diameter. A flexible eyepiece is mounted on the handle of the scope. The fiberscope has a connector that fits onto the 15-mm tracheal tube adapter and thereby allows oxygen insufflation. A cold light source or a small battery handle can be attached to the stylet handle. The tip of the Bonfils intubation fiberscope is positioned just proximal to the tip of the attached endotracheal tube, thereby preventing the lens from being soiled with blood or secretions, and to reduce any risk of mucosal trauma. We report on ten patients in whom the Bonfils intubation fiberscope was used for emergency endotracheal intubation in an Emergency Department (ED). All described cases were performed by a specialist in Anesthesia and Intensive Care Medicine, experienced in airway management procedures. The following is a paradigmatic case: a 52-year-old man was admitted to the ED with blunt thoraco-abdominal trauma, with multiple open fractures. Potential cervical spine injury was assumed by the first responders, and treated with a rigid cervical immobilization collar. The primary survey, revealed obesity (BMI: 38). The blood pressure was 70/50 mmHg, pulse rate 112 beats/min, respiratory rate 40 breaths/min, and the oxygen saturation 89% on a non-rebreathing face mask (FiO2: 1). He was alert but confused (GCS 11): the patient needed a definitive airway. He had several predictors of difficult intubation: obesity, limited neck mobility, limited mouth opening (mouth opening less than three finger breadths). The patient was supine on a long spine board. Preoxygenation was performed with 100% O2 for at least 3 min by a tight seal facemask. Bag mask ventilation (BMV) was not considered difficult, and rapid sequence intubation was performed with intravenous midazolam 5 mg, ketamine 100 mg, and succinylcholine (100 mg). The Bonfils fiberscope, armed with an 8-mm inner diameter standard endotracheal tube, was inserted with the right retromolar approach to avoid cervical movements, with a jaw thrust maneuver performed with the left hand to increase the size of the retropharyngeal space. Advancing the Bonfils into the glottic aperture, the TT was gently and successfully inserted by a counterclockwise anterior rotation under direct vision of the trachea. Tube position was further checked with chest auscultation and capnography, and the intubation time was less than 1 min. In addition to the case described above in detail, the Bonfils intubation fiberscope was electively used in nine R. M. Corso (&) G. Gambale E. Piraccini Emergency Department, Anaesthesia and Intensive Care Unit, Ospedale ‘‘G.B. Morgagni-Pierantoni’’ Viale Forlanini, 34, 47100 Forli, Italy e-mail: rmcorso@gmail.com

Management of difficult pediatric airway using bonfils fiberscope: a useful suggestion

Pediatric AnesthesiaVolume 20, Issue 4 p. 376-377 Management of difficult pediatric airway using bonfils fiberscope: a useful suggestion Rajeev Sharma, Rajeev Sharma Specialist, Department of Anesthesiology,ESI Hospital, Rohini,New Delhi 110085, India(email: rajeevkrsharmaji@gmail.com)Search for more papers by this author Rajeev Sharma, Rajeev Sharma Specialist, Department of Anesthesiology,ESI Hospital, Rohini,New Delhi 110085, India(email: rajeevkrsharmaji@gmail.com)Search for more papers by this author First published: 08 March 2010 https://doi.org/10.1111/j.1460-9592.2009.03252.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume20, Issue4April 2010Pages 376-377 RelatedInformation

Management of a difficult airway in a child with partial trisomy 1 mosaic using the pediatric bonfils fiberscope

Management of a difficult airway in a child with partial trisomy 1 mosaic using the pediatric bonfils fiberscope

More maneuvers to facilitate endotracheal intubation using the Bonfils fiberscope in children with difficult airways

Pediatric AnesthesiaVolume 19, Issue 4 p. 418-419 More maneuvers to facilitate endotracheal intubation using the Bonfils fiberscope in children with difficult airways Fu Shan Xue, Fu Shan Xue Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorXu Liao, Xu Liao Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorYan Ming Zhang, Yan Ming Zhang Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorMao Ping Luo, Mao Ping Luo Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this author Fu Shan Xue, Fu Shan Xue Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorXu Liao, Xu Liao Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorYan Ming Zhang, Yan Ming Zhang Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this authorMao Ping Luo, Mao Ping Luo Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China (email: [email protected])Search for more papers by this author First published: 12 March 2009 https://doi.org/10.1111/j.1460-9592.2008.02846.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume19, Issue4April 2009Pages 418-419 RelatedInformation

Difficult airway management with the Bonfils fiberscope in a child with Hurler syndrome

Difficult airway management with the Bonfils fiberscope in a child with Hurler syndrome

Measures to decrease failed intubation with the pediatric Bonfils fiberscope by the obscure vision

Pediatric AnesthesiaVolume 19, Issue 4 p. 419-421 Measures to decrease failed intubation with the pediatric Bonfils fiberscope by the obscure vision Fu Shan Xue, Fu Shan Xue Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorYan Ming Zhang, Yan Ming Zhang Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorXu Liao, Xu Liao Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorYa Chao Xu, Ya Chao Xu Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this author Fu Shan Xue, Fu Shan Xue Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorYan Ming Zhang, Yan Ming Zhang Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorXu Liao, Xu Liao Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this authorYa Chao Xu, Ya Chao Xu Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (email: [email protected])Search for more papers by this author First published: 12 March 2009 https://doi.org/10.1111/j.1460-9592.2008.02852.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume19, Issue4April 2009Pages 419-421 RelatedInformation

Bonfils Fiberscope: Better Preoxygenate Rather than Oxygenate!

To the Editor: Hemmerling and Bracco1 describe subcutaneous emphysema developing during use of a Bonfils fiberscope through which oxygen at a flow of 10 L/min was being used during tracheal intubation. They conclude that the problem was due to the excessive oxygen flow and comment that they have changed their practice reducing the oxygen flow to 6 L/min while using the Bonfils device. We suggest that even 6 L/min flow through the Bonfils is excessive and that the most effective maneuver for prolonging the apneic period during airway manoeuvers is preoxygenation using a high fresh gas flow and a properly applied face mask, as recommended in Difficult Airway guidelines2 or in other papers regarding Bonfils fiberscope clinical use.3 The oxygen port on the Bonfils is not intended to prolong the apneic period during tracheal intubation,1 and the risk of barotrauma might be increased (especially with large endotracheal tubes) as the tip of the tube impacts upon the larynx. For this reason the manufacturer suggests an oxygen flow of no more than 3 L/min. Dr. Hemmerling did not send a response. Massimiliano Sorbello, MD Annalaura Paratore, MD Gianluigi Morello, MD AOU Policlinico Università di Catania (Italy) [email protected] Guido Merli, MD Centro Cardiologico Monzino Milano, Italy Angela Antonietta Belluoccio, MD Flavia PetriniMD, PhD Università di Chieti—Pescara (Italy)