Comparison of the Bonfils and Levitan Optical Stylets for Tracheal Intubation: A Clinical Study

Webb, Ashley; Kolawole, Helen; Leong, Samuel; Loughnan, T. E.; Crofts, Tyron; Bowden, Chris

doi:10.1177/0310057x1103900618

Cited by 14 publications

(12 citation statements)

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“…Similarly, the reported average success rate for the Shikani Seeing Stylet in normal and difficult airways was 89% and 77%, respectively. Two studies have evaluated the Levitan stylet in unselected patients . Successful tracheal intubation during the first attempt was between 57% and 62% .…”

Section: Discussionmentioning

confidence: 99%

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins

et al. 2012

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We conducted a crossover randomised study to evaluate the performance of a novel optical stylet, the InnoScope, for tracheal intubation in simulated normal and difficult airways. Twenty-five anaesthetists attempted tracheal intubation on a SimMan 3G simulator using the InnoScope first followed by the Macintosh laryngoscope or vice versa. Three airway scenarios were tested: (1) normal airway; (2) difficult airway with swollen pharynx; and (3) limited neck movement. In each scenario, the laryngeal view, duration of and success rate for tracheal intubation were recorded. Compared with the Macintosh laryngoscope, the use of InnoScope increased the percentage of glottic opening seen by 17% in normal airway, 23% in the difficult airway and 32% with limited neck movement, p < 0.01. Despite this better laryngeal view, successful tracheal intubation achieved with the InnoScope (88.0%) was lower than that for the Macintosh laryngoscope (98.7%), p = 0.008. Using the InnoScope, tracheal intubation during the first attempt was only successful in 48% of cases with difficult airway. In this scenario, the median (interquartile range [range]) duration of tracheal intubation was significantly longer with [corrected] InnoScope compared with the Macintosh laryngoscope, (70 (19-120 [15-120)] s vs 30 [21-58 (15-120)] s, [corrected] p = 0.01. We conclude that an improved laryngeal view with the use of the InnoScope did not translate into better conditions for tracheal intubation.

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Section: Discussionmentioning

confidence: 99%

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins

et al. 2012

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“…Data collected using simulators always bear limitations concerning the translation to medical reality. A duration of 14 s until successful intubation and ventilation using a Bonfils after only four trials is obviously lower than that published for application in patients [ 38 ]. This study was conducted in an environment that was free from stress, with good lighting conditions, a comfortable working height and limited focus of the participant only on intubation and ventilation.…”

Section: Discussionmentioning

confidence: 92%

Bonfils intubation fibrescope: use in simulation-based intubation training for medical students in comparison to MacIntosh laryngoscope

et al. 2016

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BackgroundA variety of instruments are used to perform airway management by tracheal intubation. In this study, we compared the MacIntosh balde (MB) laryngoscope with the Bonfils intubation fibrescope as intubation techniques. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. Data were collected from 150 participants using an airway simulator [‘Laerdal Airway Management Trainer’ (Laerdal Medical AS, Stavanger, Norway)]. The participants were randomly assigned to a sequence of techniques to use. Four consecutive intubation ‘trials’ were performed with each technique. These trials were evaluated for differences in the following categories: the ‘time to successful ventilation‘, ‘success probability’ within 90 s,’time to visualisation’ of the vocal cords (glottis), and ‘quality of visualisation’ according to the Cormack and Lehane score (C&L, grade 1–4). The primary endpoint was the ‘time to successful ventilation‘in the fourth and final trial.ResultsThere was no statistically significant difference in the ‘time to successful ventilation’ between the two techniques in trial 4 (‘time to successful ventilation’: median: MB: 16 s, Bonfils: 14 s, p = 0.244). However, the ‘success probability’ within 90 s was higher when using a Macintosh blade than when using a Bonfils (95 vs. 87 %). The glottis could be better visualised when using a Bonfils (C&L score of 1 (best view): MB: 41 %, Bonfils: 93 %), but visualisation was achieved more rapidly when using a Macintosh blade (median: ‘time to visualisation’: MB: 6 s, Bonfils: 8 s, p = 0.003).ConclusionsThe time to ventilation using the MacIntosh blade and Bonfils mainly did to differ, however success probabilities and time to visualisation primary favoured the MacIntosh blade as intubation technique, although the Bonfils seem to have a steeper learning curve. The Bonfils is still a promising intubation technique and might be easier to learn as the MB, at least in a manikin.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-1937-2) contains supplementary material, which is available to authorized users.

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“…It has been successfully used in patients with both predicted and unpredicted difficult airways [3, 4]. It has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands [5]. …”

Section: Discussionmentioning

confidence: 99%

Use of the Bonfils Intubation Fiberscope in Patients with Limited Mouth Opening

Shollik

Ibrahim

Ismael

et al. 2012

Case Reports in Anesthesiology

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Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening.

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Comparison of the Bonfils and Levitan Optical Stylets for Tracheal Intubation: A Clinical Study

Cited by 14 publications

References 11 publications

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins

A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins

Bonfils intubation fibrescope: use in simulation-based intubation training for medical students in comparison to MacIntosh laryngoscope

Use of the Bonfils Intubation Fiberscope in Patients with Limited Mouth Opening

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