A Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients with a Simulated Difficult Airway

Abdullah, Hairil Rizal; Teo, L.W.; Marriott, Andrew; Wong, Theodore Gar-Ling

doi:10.1213/ane.0b013e3182a46fa9

Cited by 10 publications

(21 citation statements)

References 7 publications

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“…Therefore the interincisor distance, sternomental distance, thyromental distance, and modified Mallampati tests are all predictor of a difficult airway [ 9 ]. At this point, several studies have been performed by applying a cervical collar for the limitation of cervical movement and mouth opening [ 5 , 10 , 11 , 12 , 13 ]. The results of our study showed a decreased interincisor distance and range of neck movement after application of the cervical collar.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway

Yang

Jeong

Song

et al. 2015

Korean J Anesthesiol

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BackgroundAlthough Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation.MethodsFifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects.ResultsThere was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008).ConclusionsIn a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.

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Section: Discussionmentioning

confidence: 99%

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway

Yang

Jeong

Song

et al. 2015

Korean J Anesthesiol

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“…Inspection of the forest plot of 4 available studies [21–23,25] that recruited a total of 297 patients (video-stylet group, n = 149 vs laryngoscope group, n = 148) revealed a comparable intubation time between the video-stylet and the laryngoscope groups (MD = 4.53, 95% CI: –8.45 to 17.51, P = .49; I 2 = 85%) (Fig. 5).…”

Section: Resultsmentioning

confidence: 99%

Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis

Chen

Hung

et al. 2022

Medicine

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Background: Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization. Method: The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage. Results: Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89–1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93–1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: –8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16–1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23–0.9, P = .02). Conclusion: Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.

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“…35 However, our group of consultant anaesthetists have extensive experience in using the Bonfils fibrescope in difficult airway patients under anaesthesia, and there are increasing data to support its use in difficult airways. 35–37 The Bonfils fibrescope has advantages over other forms of indirect laryngoscopy in patients with peri-glottic lesions due to its increased manoeuvrability around these lesions, and its rigid stylet component can push lesions aside and can also act as a guide for tracheal tube rail-roading and subsequent insertion through a distorted peri-glottis. 32,38 As far as we are aware, this is the largest reported case series on the use of the Bonfils fibrescope in H&N patients.…”

Section: Discussionmentioning

confidence: 99%

Head and neck surgery in a tertiary centre: Predictors of difficult airway and anaesthetic management

Wong

Iqbal

Light

et al. 2015

Proceedings of Singapore Healthcare

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Introduction: The management of head and neck surgical patients is associated with increased morbidity and mortality, and so anticipating the difficult airway is important. Methods: We undertook a prospective survey on consecutive adult patients scheduled on the elective operating lists of four head and neck consultant surgeons. Data were collected over a 36 month period. Data included: patient characteristics; routine predictors of difficulty in airway management (bedside tests of the airway, a history of previous surgery or radiotherapy and the presence of airway symptoms); laryngoscopy grade; method of anaesthesia and airway management; and any airway complications arising during induction of anaesthesia and extubation. Results: The 'study' group consisted of 818 patients. The 'direct laryngoscopy' group contained 674 patients, that is, patients who had direct laryngoscopy and could therefore be classified as easy or difficult intubation. The prevalence of difficult intubation was 12.6%. Factors or tests that were statistically significantly associated with difficult intubation were: history of difficult airway; previous head or neck radiotherapy treatment; presence of airway symptoms; presence of moderate or severe limited neck movement; and short interdental distance. The sensitivity, specificity and positive predictive values were: history of difficult airway 16.5%, 98.6% and 63.6%; previous radiotherapy 12.9%, 96.6% and 35.5%; airway symptoms 42.9%, 69.6% and 15.9%; moderate/ severe neck limitation 16.7%, 97.2% and 46.7%; Mallampati score 3 or 4, 38.8%, 83.8% and 25.8%; and interdental distance 9.4%, 98.8% and 53.3%, respectively. The Bonfils intubation fibrescope was the most commonly used indirect laryngoscopy device (63.9% of all such cases). Twenty-six patients (3.2%) had complications during their initial airway management after induction of anaesthesia. There was one case of 'cannot intubate, cannot oxygenate', which required an emergency tracheostomy. Conclusion:The prevalence of difficult intubation in head and neck surgical patients was higher than in the general population, but predictive tests for difficult intubation have poor to moderate value. In our study, rates of difficult face mask ventilation, failed intubation and complications during induction and extubation were low. However, serious morbidity, although rare, can still be encountered. Head and neck surgical patients can be managed safely in a tertiary centre where there is appropriate surgical and anaesthetic expertise in managing difficult airways.

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A Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients with a Simulated Difficult Airway

Cited by 10 publications

References 7 publications

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway

Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis

Head and neck surgery in a tertiary centre: Predictors of difficult airway and anaesthetic management

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