Comparison of the Levitan FPS Scope^™ and the single‐use bougie for simulated difficult intubation in anaesthetised patients

Abstract

SummaryA randomised cross-over study was performed in 34 patients with no evidence of airway difficulties, following induction of general anaesthesia, to compare the efficacy of the Levitan FPS scope TM (LFPS) and the single-use bougie for tracheal intubation during simulated grade IIIa laryngoscopy. Success rates for intratracheal placement of the device, and the time required for insertion and tracheal intubation were recorded. Both devices were equally successful (31 ⁄ 34 for the LFPS vs 29 ⁄ 34 for the bougie) for insertion into the glottis. The mean insertion time for the LFPS was statistically longer than that for the bougie (4.4-12.5 s) but this difference was not clinically relevant. Intubation times were similar between the two devices. Major problems hindering successful intubation using the LFPS were the presence of a narrow epiglottic-pharyngeal wall space and copious secretions. An inability to maintain the desired shape was the principal cause of failure with the bougie.

The Shikani optical stylet as an alternative to the GlideScope® videolaryngoscope in simulated difficult intubations – a randomised controlled trial

“…The manufacturer has recommended a variety of intubation techniques: as a stand‐alone device; its use with a Macintosh blade; or with a ‘chin‐lift’ technique. Although several such malleable fibre optic scopes have been available for some time [10], there is still a paucity of literature documenting their clinical efficacy in managing the difficult airway [11, 12]. Hence, we evaluated the use of the Shikani optical stylet as an alternative to the GlideScope videolaryngoscope in anaesthetised patients with cervical immobilisation simulating a difficult airway.…”

Effectiveness and safety of the Levitan FPS Scope™ for tracheal intubation under general anesthesia with a simulated difficult airway

“…In previously published studies evaluating newer fibreoptic scopes, the laryngeal view was not graded or the mannequin or patients had a predetermined Cormack-Lehane grade. 2,10,11 With respect to safety, we found no difference in the frequency of trauma or complaints of sore throats between Data presented as mean difference and 95% confidence intervals (paired one-way analysis of variance). SBP = systolic blood pressure; HR = heart rate the LFS and Macintosh as the technique used for actual tracheal intubation.…”

“…These results support Greenland et al's previously reported findings published in a similar bougie vs LFS study. 2 These authors reported longer LFS insertion times, yet both techniques were equal in time to intubate and success at intubating the trachea in standardized simulated grade IIIa difficult airways.…”

“…Several studies show that the LFS is analogous to a bougie in simulated difficult airways with comparable tracheal intubation success rates, yet these studies did not compare glottic views (i.e., standardized views) or were completed on mannequins. 2,3 We hypothesized that the LFS can be more effective and safer than the Macintosh laryngoscope alone when used for direct laryngoscopy and tracheal intubation of subjects with a simulated difficult airway using manual in-line stabilization (MILS). This study aims to extrapolate useful clinical information from the MILS simulated difficult airway scenario for use in patients with true difficult airways in the hospital setting.…”

Man vs. manikin revisited - the ethical boundaries of simulating difficult airways in patients

“…Simulating a difficult airway in patients for the purpose of clinical study is not a new concept, with several approaches described. Two commonly adopted methods include: undertaking direct laryngoscopy with a Macintosh laryngoscope blade, then reducing traction, allowing the epiglottis to fall posteriorly, thereby creating an obscured view of the vocal cords with an adjustable degree of difficulty ; and application of a rigid cervical collar, as favoured by Kleine‐Brueggeney et al, designed to create a physical restriction of neck flexion, head extension and mouth opening as might occur in a patient with cervical spine instability. Since there are advantages and disadvantages of both of these techniques (in terms of airway accessibility, practicality, reliability, reproducibility and generalisability), the choice of which technique to adopt is largely governed by the nature of the difficult airway intended and the type of airway device or technique under investigation.…”