Comparative randomised study of GlideScope^® video laryngoscope versus flexible fibre-optic bronchoscope for awake nasal intubation of oropharyngeal cancer patients with anticipated difficult intubation

Abstract

Background and Aims:Awake flexible fibre-optic bronchoscope (FFS) is the standard method of intubation in difficult airway in oral cancer patients. We decided to evaluate GlideScope® video laryngoscope (GL) for intubation as compared to the standard FFS for nasal intubation in such patients.Methods:After the ethical committee approval, we included 54 oropharyngeal cancer patients divided randomly into two equal groups: Group G and Group F. After pre-medication and pre-oxygenation, awake nasal intubation was performed using GL in Group G and FFS in Group F. In both groups, we compared intubation time in seconds (mean ± standard deviation) (primary outcome), success rate of the first intubation attempt, percentage of Cormack and Lehane glottic score and incidence of complications. We assumed that GL could be a suitable alternative for the standard FFS in nasal intubation of patients with oropharyngeal cancer. Success rate of the first attempt and Cormack and Lehane glottic score were compared using Chi-square test.Results:Intubation time in seconds was significantly shorter in Group G (70.85 ± 8.88 S) than in Group F (90.26 ± 9.41 S) with (P < 0.001). The success rate of the first attempt intubation was slightly higher in Group G (81.5%) than Group F (78.8%). Cormack and Lehane glottic Score I and II showed insignificant difference between both Group G (92.6%) and Group F (96.3%). We detected three cases of sore throat in each group.Conclusion:GlideScope® could be a suitable alternative to FFS in nasal intubation of oropharyngeal cancer patients.

Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta‐analysis

“…) demonstrated no significant difference in the number of failed intubations between the groups. Similarly, analysis of the six studies (391 participants) that reported on the number of successful intubations on the first attempt showed no difference between the groups (Fig. ).…”

“…Eight studies were eventually included in our review . We excluded one study from the meta‐analysis due to incomplete data reporting .…”

“…Five different types of videolaryngoscopes were used: GlideScope ™ in four studies ; Bullard ™ laryngoscope ; McGrath series 5 ™ ; C‐MAC D‐blade ™ and Pentax AWS ™ (each in one study). Two types of fibreoptic bronchoscopes were used; the Karl Storz fibrescope in two studies and the Olympus fibrescope in four studies . Two studies did not specify the type of fibreoptic bronchoscope used .…”

“…In most of the included studies, intubations were performed via the oral route. Only in two studies was the nasal route used for intubation .…”

Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

“…All of these studies showed that as with awake fiberoptic intubation, awake VL-assisted intubation achieved a high success rate, satisfactory intubation times, and a high acceptance of patients and anesthesiologists. Thus, it is concluded that in patients with predicted and known difficult intubations, awake VL-assisted intubation represents an acceptable alternative to awake fibreoptic intubation (36)(37)(38)(39)(40).…”