Fiberoptic Tracheal Intubation Research Articles

I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel

The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4–39.0) s, vs standard i-gel: 54.7 (29.6–135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0–105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.

Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fiberoptic tracheal intubation on a difficult airway model: a randomized controlled non-inferiority trial

The management of patients with history or suspicion of difficult intubation can be challenging, especially in surgical procedures requiring one-lung ventilation. The ease of insertion of silicone double lumen tube (DLT) have previously been shown to be comparable to polyvinyl single lumen tube (SLT) in fiberoptic bronchoscope (FOB) tracheal intubation. Hence, in difficult airway situation, we hypothesized that the performance of insertion of silicone DLT would also be non-inferior to polyvinyl SLT in FOB intubation. We used a neck collar to mimic patients with difficult airway. 80 patients who required one-lung ventilation were enrolled in a prospective, randomized, non-inferiority trial. Patients were randomly allocated to the DLT or SLT groups (SLT with bronchial blocker). Neck collar was supplied to all patients before FOB intubation. The time of insertion for FOB, railroading, tracheal intubation, and total procedure were measured. The difficulty of railroading was evaluated in 4 grades. In the DLT group, the railroading was significantly shorter and easier comparing to the SLT group. The total procedure was also simpler and faster in the DLT group. While simulated difficult airways may not fully replicate actual difficult airways, we suggest that fiberoptic intubation with silicone DLT could be a feasible first-line option for patients with expected difficult airways requiring lung separation, unless the size of the DLT relative to the patient’s airway is problematic.Trial registration: NCT03392766.

A Comparative Study of Nasal Fiberoptic Intubation with Laryngeal Mask Airway Fiberoptic Intubation in Children with a Difficult Airway

Background: Considering that the gold standard for intubation in children with a difficult airway is the use of fiberoptic bronchoscopy, and few studies have evaluated its application in children, the present study aimed at comparing two bronchoscopic techniques of nasal fiberoptic tracheal intubation (FOI-Nasal) and fiberoptic intubation via laryngeal mask airway (FOI-LMA) in children with a difficult airway.
 Methods: A single-blind randomized clinical trial was performed on 40 six-month-old to six-year-old children that were divided into two groups each consisting of 20 patients. The participants were all candidates for elective surgery with clinical criteria for the anticipated difficult intubation. FOI-Nasal and FOI-LMA were performed in the first and second groups, respectively. Mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation levels (SpO2) were assessed and recorded before anesthesia (T1), immediately before bronchoscopy (T2), and immediately after intubation with endotracheal tube (T3). Moreover, ETCO2, the first successful insertion attempt, and the intubation time were recorded, as well.
 Results: The results of the present study revealed that parameters including MAP, HR, and SpO2 at times T1, T2, and T3 were not significantly different between the two groups after adjusting for potential confounding factors (P> 0.05). However, ETCO2 in FOI-Nasal group with a mean of 38.40 ± 3.57 was significantly higher than that of the FOI-LMA group with a mean of 34.35 ± 3.15 (P = 0.001). In addition, the intubation time in the FOI-LMA group with a mean of 32.40 ± 7.45 was significantly shorter than that of the FOI-Nasal group with a mean of 51.75 ± 9.97 (P <0.001). The success rate in the first attempt in the FOI-Nasal group with the value of 70% was lower than that of the FOI-LMA group with the value of 90%; however, this difference was not statistically significant (P> 0.05).
 Conclusion: According to the results of the present study, the intubation time in the FOI-LMA group was significantly shorter than that of the FOI-Nasal group. Moreover, the success rate of the first attempt in the FOI-LMA group was higher than that of the FOI-Nasal group. Therefore, it can be stated that FOI-LMA as compared to FOI-Nasal can be regarded as an easier technique, with a shorter intubation time, a higher success rate, and a greater stability of children’s hemodynamic parameters.

Acute lethargy, stridor, and hypoxemia in a young adult.

A young adult with intellectual delay presented to the emergency department (ED) from a group home via ambulance with altered mental status and respiratory distress. The patient was known to be non-verbal but definitely alert and interactive at baseline. On arrival, the patient was lethargic with frequent coughing and notable stridor, unable to obey commands. Emergency medical services reported SpO2 was initially 85%, but the hypoxemia had improved with supplemental oxygen administered via non-rebreather mask. Partial airway obstruction was suspected due to the stridor, and it was feared that the paralysis of rapid sequence intubation might result in a “can't oxygenate, can't ventilate” scenario. Preparations were made for immediate emergency airway management with a dual set-up for awake fiberoptic tracheal intubation and a cricothyroidotomy. Nasal cannula was applied at flush rate with SpO2 sustained at 100% throughout the procedure. Ketamine was used to facilitate fiberoptic nasopharyngoscopy, which identified a green foreign body obstructing a view of the entire glottis. Standard geometry video laryngoscopy was then employed to guide foreign body retrieval with Magill forceps and a DuCanto (SSCOR, Inc) suction catheter (Video 1). It was evident during removal that the foreign body was aspirated broccoli. The patient recovered from sedation and had no further need for supplemental oxygen in the ED. The patient was treated for aspiration pneumonia, admitted for observation, and was discharged at their neurologic baseline the next day. Incomplete foreign body airway obstruction (FBAO) is a time-sensitive emergency that mandates urgent intervention before progression to complete obstruction, which will always rapidly deteriorate to cardiac arrest. Immediate removal is critical to patients surviving with good neurologic outcomes in the event of a cardiac arrest.1 Operators should be prepared to follow well-established algorithms for the management of incomplete and complete FBAOs.2 Magill forceps have been part of airway management for over a century3 and are known to be effective in removing FBAOs in prehospital cardiac arrests.4 The DuCanto (SSCOR, Inc) suction catheter is a wide-bore rigid suction catheter that has been shown to effectively remove viscous liquid in simulated airway contaminations5 but was successful in removing smaller solid foreign bodies for this case. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Comparison of three video-assisted intubation methods: Rigid telescopes, C-MAC, flexible fiberoptic bronchoscopy, for anticipated difficult airways

ObjectiveThe aim of this study was to compare the efficiency and reliability of rigid telescopes with the two most used video-assisted intubation techniques. The primary outcome of the study is the first attempt orotracheal intubation success rate and the secondary outcomes include intubation time, mucosal injury, and complications during intubation. Materials and methodsAll patients that were predicted to have difficult intubation were prepared according to the video-assisted intubation technique and were randomly divided into three groups: Group 1 (REI group; n = 49) included patients that were intubated using rigid endoscope-assisted orotracheal intubation (REI) (0°, 45°, and 70°), 18-cm rigid telescope, full-HD camera, and Macintosh blade. Group 2 (V-MAC Group; n = 51) included patients that underwent tracheal intubation using a videolaryngoscope Macintosh (V-MAC). Group 3 (FFEI group; n = 53) included patients that underwent flexible fiberoptic tracheal intubation. Groups were compared with regard to intubation success rate, intubation time, number of intubation attempts, and intubation-related complications. ResultsThe study included a total of 153 patients aged 18–60 years who were predicted to have difficult intubation and underwent intubation with phonomicrosurgery and general anesthesia under elective conditions. Demographic and airway findings of the groups were similar, and no significant difference was found among the groups with regard to the number of intubation attempts (p > 0.05). Intubation was successful at the first attempt in 110 (72%), at the second attempt in 26 (17%), and at the third attempt in 17 (11%) patients. No significant difference was found among the three groups with regard to the number of intubation attempts (p > 0.05). Intubation time was significantly longer in the FFEI group compared to the other two groups (p < 0.05). The prevalence of mucosal injury to vocal cords was significantly lower in the REI group compared to other groups (p < 0.05). ConclusionRigid telescopes can be considered in elective surgeries of patients predicted to have difficult airway since they allow for rapid assessment of the airway, minimal mucosal damage, and rapid intubation.

Efficiency of laryngeal mask airway ProtectorTM and i-gel® as a conduit in Aintree catheter-guided fibreoptic tracheal intubation: a randomised clinical trial.

Fibreoptic intubation through a supraglottic airway device (SAD) is recom-mended in difficult airway management algorithms. The Difficult Airway Society published a guideline describing the details of this technique in 2011. This study was designed to compare the efficiency of two different 2nd generation SADs as a conduit for Aintree catheter-guided fibreoptic tracheal intubation. 80 adult patients with an ASA score of 1-3 undergoing elective surgical procedures were included in the study. The patients were intubated after randomization to two groups: the i-gel group and the laryngeal mask airway (LMA) Protector group. SAD insertion time and tracheal intubation time were recorded separately. Demographic data, changes in haemodynamic parameters during the procedure, and complications were noted. In the LMA Protector and i-gel groups, the number of attempts (1.14 ± 0.35 vs. 1.24 ± 0.49 times, P = 0.394), device insertion time (14.89 ± 8.11 vs. 17.84 ± 16.59 seconds, P = 0.896), and the need for an optimization manoeuvre (43.2% vs. 37.8%, P = 0.813) were similar (P > 0.05). The fibreoptic laryngeal appearance scale and haemodynamic parameters were similar (P > 0.05). However, the airway complication rate was significantly higher in the LMA Protector group than in the i-gel group (21.6% vs. 2.7%, P = 0.013). The most common complications were bronchospasm and bloody secretion on SAD. With the stable haemodynamic parameters, acceptable insertion time and lower complication rate, we concluded that the i-gel may be preferable in fibre-optic tracheal intubation. The rigid structure of the LMA Protector compared to the i-gel might contribute to this result.

Awake nasotracheal intubation with a 300-mm working length fiberscope: a prospective observational feasibility trial

BackgroundAwake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases. MethodsThis was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients’ periprocedural satisfaction and other incidents were recorded. ResultsWe successfully intubated all 25 patients included in this study. The mean ±SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 – mild discomfort. No significant incidents occurred. ConclusionsOur study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways.

Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal Intubation in Anaesthetised Spontaneously Breathing Paediatric Patients.

ObjectiveFlexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route.MethodsSixty children aged 6–12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded.ResultsThe time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting.ConclusionIntubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6–12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Awake videolaryngoscopy for tracheal intubation with double-lumen tube in thoracic surgery: an acceptable alternative to fiberoptic tracheal intubation?

Awake videolaryngoscopy for tracheal intubation with double-lumen tube in thoracic surgery: an acceptable alternative to fiberoptic tracheal intubation?

The Effect of Anaesthesia on Oral Fibreoptic Tracheal Intubation in A Patient of Ankylosing Spondylitis

Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anaesthesiologists. The fibreoptic intubation (FOI) is designed to assist tracheal intubation for patients with a difficult airway. If we chose to do FOI, our first step is to decide whether to do a fibreoptic intubation with the patient anesthetized or awake. Once we’ve decided on anesthetized or awake, chose either the oral or nasal route. The aim of the study was to report the successful intubation by anesthetized nasal fibreoptic tracheal intubation of an AS patient after the failed intubation by anesthetized oral fibreoptic tracheal intubation because of a difficult airway found, and to discuss the effect of anaesthesia on oral fibreoptic tracheal intubation in patients with AS.

Pecha Kucha with Part-Task Training Improves Airway Management in Fresh Frozen Cadavers: A Case-Control Observational Study

Objective: The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. Subjects and Methods: The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (n = 9) received part-task training and group 2 (n = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. Results: Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (p < 0.05). Conclusion: In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D, Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial.

The use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario. We compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin. Thirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation. All participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42s, 56s, and 56s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29s and 40s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation. In an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.

Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fibreoptic tracheal intubation in patients with semi-rigid neck collar: a randomized controlled non-inferiority trial

Introduction Direct insertion of a double-lumen tube over a fibreoptic bronchoscope is considered more difficult and traumatic than that of a single-lumen tube, especially in patients with difficult airway. We hypothesized that time to intubation over fibreoptic bronchoscope using a silicone double-lumen tube would be non-inferior to that using a polyvinyl chloride single lumen tube in patients with semi-rigid neck collar. Methods Fifty patients were randomly allocated to fibreoptic tracheal intubation with either a silicone double-lumen tube or polyvinyl chloride single lumen tube with bronchial blocker (DLT and SLT groups, respectively). Time to tracheal intubation (time to insertion of fibreoptic bronchoscope plus railroading [advancement over the fibreoptic bronchoscope] time); total time for correct tube and bronchial blocker positioning; difficulty of railroading; and the incidence of sore throat, swallowing difficulty, and hoarseness were compared between groups. Results The median time to intubation over the fibreoptic bronchoscope was 24 s in the DLT group and 23 s in the SLT group. The upper limit of the confidence interval of this difference was below the non-inferiority margin of 10 s (median difference: –1 s; 95% confidence interval: –5 to 4 s). Railroading over the fibreoptic bronchoscope (rated on a four-point scale) was regarded as less difficult in the DLT group than in the SLT group (p Discussion Tracheal intubation using fibreoptic bronchoscope can be achieved at least as fast using the silicone double-lumen tube as using the polyvinyl chloride single lumen tube in patients with semi-rigid neck collar. Railroading the silicone double-lumen tube was easier than that of the polyvinyl chloride single lumen tube.

Time to tracheal intubation over a fibreoptic bronchoscope using a silicone left double-lumen endobronchial tube versus polyvinyl chloride single-lumen tube with bronchial blocker: a randomized controlled non-inferiority trial.

Direct insertion of a double-lumen endobronchial tube (DLT) over a fibreoptic bronchoscope (FOB) is considered more difficult and traumatic than that of a single-lumen tube (SLT). We hypothesized that time to intubation over an FOB using a silicone left DLT would be non-inferior to that using a polyvinyl chloride (PVC) SLT. Eighty patients were enrolled in this open-label, randomized controlled, non-inferiority trial. Patients were randomly allocated to fibreoptic tracheal intubation with either a silicone DLT or PVC SLT (DLT and SLT groups, respectively). Time to tracheal intubation [time to insertion of FOB plus railroading (advancement over the FOB) time]; total time for correct tube and bronchial blocker positioning; difficulty of railroading; and the incidence of sore throat, swallowing difficulty, and hoarseness were compared between groups. The median time to intubation over the FOB was 20 s in the DLT group and 23 s in the SLT group. The upper limit of the confidence interval of this difference was below the non-inferiority margin of 10 s (median difference: -2 s; 95% confidence interval: -4 to 0 s). Railroading time was significantly shorter in the DLT group than in the SLT group (median time: 10 vs. 11 s; median difference: -1 s; 95% confidence interval: -3 to 0 s; P=0.03). Railroading over the FOB (rated on a four-point scale) was less difficult in the DLT group than in the SLT group (P<0.01). Tracheal intubation using an FOB can be achieved at least as fast using the silicone DLT as using the PVC SLT. The silicone DLT exhibited superior railroading performance to the PVC SLT.

Comparison between three supraglottic airway devices as conduits for fiber-optic tracheal intubation

Background Securing the airway is a major task for anesthesiologists. Supraglottic airway devices (SADs) are widely used nowadays. Fiber-optic endotracheal intubation (ETT) plays an important role in difficult-to-manage airways. The general purpose of a conduit is to provide a clear protected pathway for the expensive, sensitive, and fragile fiber-optic cable. Aimof the work To compare between three SADs as conduits for fiber-optic tracheal intubation. Patients and methods A prospective, randomized study involving 81 adult patients (American Society of Anesthesiologists I or II), of both sexes who were allocated into three groups (27 patients each): Air-Q group (group Q), intubating laryngeal mask airway (ILMA) group (group L) or I-Gel group (group G). Fiber-optic ETT through SADs was performed. The number of attempts and duration of insertion of SAD, laryngeal view grading, number of attempts, and duration of insertion of ETT were assessed. Complications were recorded. Results The ease and number of attempts to insert SADs showed no statistically significant differences. The duration of insertion of SADs was statistically favoring the Air-Q intubating laryngeal airway (13±3 s), compared with ILMA (19±4 s) and I-Gel (18±3 s). The fiber-optic grading of laryngeal view through SADs also favored group Q compared with other groups. Number of attempts to insert ETT through SADs showed no statistically significant differences between groups. The duration of insertion of the ETT via fiber-optic bronchoscopic through the SADs showed highly statistically significant difference (P Conclusion Air-Q, ILMA, and I-Gel were useful conduits for fiber-optic ETT. Air-Q intubating laryngeal airway provides better visualization of the glottis and shorter time for insertion of both the device and the ETT than ILMA and I-Gel.

Effectiveness of tip rotation in fibreoptic bronchoscopy under different experimental conditions: an in vitro crossover study

BackgroundProper manipulation of fibreoptic bronchoscopes is essential for successful tracheal intubation or diagnostic bronchoscopy. Failure of proper navigation and rotation of the fibrescope may lead to difficulties in advancing the fibrescope and might also be responsible for (unnecessary) difficulties and delays in fibreoptic tracheal intubation, with subsequent hypoxaemia. The present study, therefore, aimed to assess the effectiveness of tip rotation in flexible bronchoscopes in different experimental conditions. MethodsFive differently sized pairs of fibrescopes (outer diameters of 2.2, 2.4, 3.5, 4.2, and 5.2 mm) were inserted into paediatric airway manikins via an appropriately sized laryngeal mask and were turned clockwise or anticlockwise at the fibrescope body or cord to 45, 90, and 180°, with the cord held either straight or bent. The primary outcome measure was the ratio of rotation measured at the tip over the rotation performed with the fibrescope body or cord. ResultsOverall, the ‘body’ turn was significantly less effective when a bent cord was present (mean difference ranging from 29.8% (95% confidence interval 8.8–50.9) to 117.4% (93.6–141.2). This difference was diminished when the ‘cord’ turn was performed. Smaller fibrescopes, with outer diameters of 2.2 and 2.4 mm, were inferior with respect to the transmission of ‘body’ rotation to the tip. Conclusions‘Cord’ turning of the fibrescope appears to be more effective in rotating the tip than a turn of the fibrescope ‘body’ only. Straightening the fibrescope cord and combined ‘body’ and ‘cord’ turning are recommended.

Comparison of the paediatric blade of the Pentax-AWS and Ovassapian airway in fibreoptic tracheal intubation in patients with limited mouth opening and cervical spine immobilization by a semi-rigid neck collar: a randomized controlled trial

BackgroundWe compared the performances of the paediatric blade of a Pentax Airway Scope and an Ovassapian airway in fibreoptic tracheal intubation in patients whose necks were stabilized by semi-rigid neck collars. MethodsNinety patients were enrolled in this prospective, open-label, randomized controlled trial. Patients were randomly allocated to one of two groups (Group OVA-FOB and Group AWS-FOB). The time to tracheal intubation, success rate of tracheal intubation, number of optimization manoeuvres (jaw thrust), and difficulty of manipulation of the fibreoptic bronchoscope were compared between the groups. ResultsThe time to tracheal intubation was significantly shorter (32 vs 50 s; median difference 19 s; 95% confidence interval 14–25 s; P<0.001) and manipulation of the fibreoptic bronchoscope was significantly easier for Group AWS-FOB. Optimization manoeuvres were rarely required to facilitate fibreoptic tracheal intubation in Group AWS-FOB [jaw thrust, 0 (0%); jaw thrust with anterior neck collar removal, 1 (2%)] compared with that required in Group OVA-FOB [jaw thrust, 39 (87%); jaw thrust with anterior neck collar removal, 2 (4%)]. There was no significant difference in the success rate of tracheal intubation on the first attempt between groups [Group AWS-FOB, 45 (100%); Group OVA-FOB, 44 (98%)]. ConclusionsCombined use of the paediatric blade of a Pentax Airway Scope and a fibreoptic bronchoscope enabled rapid tracheal intubation, minimizing the use of external manoeuvres of the airway, in patients with limited mouth opening and cervical spine immobilization by semi-rigid neck collars, compared with use of the Ovassapian airway and the fibreoptic bronchoscope. Clinical trial registrationNCT02827110.

Human cadavers preserved using Thiel's method for the teaching of fibreoptically‐guided intubation of the trachea: a laboratory investigation

We assessed the suitability of human cadavers preserved using Thiel's method for teaching flexible fibreoptic tracheal intubation. Thirty-one anaesthetists unacquainted with this technique received didactic teaching followed by handling of the fibrescope on the Oxford teaching box. They then carried out fibreoptic intubations in two cadavers to establish a baseline sample of their intubation skills. Thereafter, we randomly assigned the trainees to two groups to practice fibreoptic intubation either on two distinct cadavers or on two airway manikins. After 7days we re-assessed procedural skills using the same cadavers as at baseline. Intubation time was the primary outcome and secondary outcomes included the incidence of failed intubations. We also evaluated trainee satisfaction. The mean (SD) intubation time decreased from a baseline value of 74 (20)s to 35(6)s in the cadaver group and to 56 (16)s in the manikin group. The effect of 'time' was significant (p=0.002), indicating that both methods of training led to improvements. The training effect of the cadaveric method was greater than with the manikin method (p=0.0016). Thirty-four failed intubations occurred at baseline vs. eight at the end of study (RR 0.24, 95%CI 0.11-0.51, p=0.0002, NNT 9.6); six in the cadaver group and two in the manikin group (p=0.22). We conclude that human cadavers preserved using Thiel's method are potentially better for teaching flexible fibreoptic tracheal intubation compared with manikins.

FIBEROPTIC TRACHEA INTUBATION

The article presents the analysis of the existing literature on the use of fiberoptic facilities during challenging tracheal intubation. Awake fiberoptic intubation is the «gold standard» for difficult intubation cases in selective surgery. However, in emergency cases there is no clear rule for particular fiberoptic bronchoscope intubation method (awake, under anaesthesia with neuroomuscular relaxants or without them). Moreover, fiberoptic bronchoscope intubation technique is not described and valid enough. This is why further shared and generalized experience of fiberoptic tracheal intubation is needed, primarily for anesthetic management of emergency operations.