A comparison of Bonfils intubation fiberscopy and fiberoptic bronchoscopy in difficult airways assisted with direct laryngoscopy

Abstract

BackgroundTo evaluate the usefulness of Bonfils intubation fiberscope assisted by direct laryngoscopy (BIF-DL) and flexible fiberoptic bronchoscope assisted by direct laryngoscopy (FOB-DL) using video recording in cases of unanticipated difficult intubation with respect to the time required to visualize the vocal cords and place the endotracheal tube. We compared two fiberscopes in patients with authentic difficult airways.MethodsIn this randomized, controlled clinical trial, 40 patients (grade 3 according to grades of difficulty in laryngoscopy), scheduled for surgery under general anesthesia were randomly allocated to BIF-DL group or FOB-DL group. Number of attempts, time required for visualization of the vocal cord (T1) and placement of the endotracheal tube (T2) from insertion of instrument during the last successful attempt, and duration of scope manipulation during all attempts (Ttotal) were recorded. If intubation failed with one method, the other method was tried; these cases were then excluded. The incidence of sore throat and hoarseness was assessed.ResultsT1, T2, and Ttotal were significantly shorter in BIF-DL group (T1: 21.9 ± 8.2 sec vs. 80.4 ± 29.9 sec, P < 0.001, Ttotal: 77.9 ± 41.2 sec vs. 145.5 ± 83.9 sec, P = 0.003). In two cases, it was impossible to intubate with BIF-DL, but the procedure was subsequently successful using fibreoptic bronchoscope.ConclusionsIntubation of difficult airways can be performed more rapidly with BIF-DL, but sometimes it may not be possible to intubate with the scope.

Predictors of Difficult Intubation with the Bonfils Rigid Fiberscope

“…Rudolph et al 11 had a 100% success rate with BRF in the unanticipated difficult airway (n = 116), including success with BRF after 2 failed attempts at fiberoptic bronchoscopy intubation. Kim et al 10 had a 90% (18/20) success rate with BRF. In this study, Cormack and Lehane grade III at DL was observed in 6 (1.5%) patients, an incidence similar to previous studies that noted only the best glottic view obtained with or without backward upward rightward pressure 28 ; BRF intubation without assistance with a laryngoscope was successful in 5 of these 6 patients (83%).…”

“…In all 4 cases where intubation with the BRF alone was not successful, failure to visualize the glottis appeared to be the result of difficulty in mobilizing the epiglottis to create an opening between it and the posterior pharyngeal wall without the BRF passing directly into the esophagus. DL performed simultaneously with BRF is a technique that has been described before 10 and that allows the anesthesiologist to lift the epiglottis off the posterior pharynx. When attempted in 2 of the cases of failed BRF in this study, this technique proved successful.…”

“…Intubation with the BRF is described in patients with normal airways, patients with obstructing airway tumors, and patients with anticipated and nonanticipated difficult airways, including patients with failed intubation attempts with DL. [8][9][10][11] The very different design and high success rate of the BRF in intubation situations where DL is difficult raise the question of whether demographic, morphologic, or morphometric predictors of difficult DL also predict difficult BRF. A prospective study was therefore designed to determine which patient characteristics, if any, predict difficult BRF intubation in an elective surgical population.…”

The performance of rigid scopes for tracheal intubation: a randomised, controlled trial in patients with a simulated difficult airway

“…They are fast to set up, portable and more durable than flexible scopes . Their use may be associated with a higher success rate than Macintosh laryngoscopes in difficult airway scenarios , and, compared with flexible scopes, rigid scopes may reduce intubation time . Also, complication rates are similar to flexible scopes and the Macintosh laryngoscope .…”

Predictors of Difficult Airway Management in Thyroid Surgery: A Five-Year Observational Single-Center Prospective Study

“…Macroglossia was identified as an independent risk factor in other studies as well 27 . Many studies indicate the necessity of additional equipment besides the standard Macintosh laryngoscope, primarily fiber optic bronchoscope in order to resolve a problematic airway [28][29][30] . In all patients, including those who had a very high-risk score and where it was almost certain that DI would occur, we primarily tried to intubate in a conventional manner, using Macintosh laryngoscope.…”