Fiberoptic Intubation: An Overview and UpdateDiscussion

Collins, Stephen R.; Blank, Randal S.

doi:10.4187/respcare.03012

Cited by 147 publications

(108 citation statements)

References 118 publications

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“…Some case reports also describe the successful use of these tools under sedation with preserved spontaneous breathing [8][9][10][11][12][13]. However, the standard -and up to now, probably safest -technique for the management of an anticipated difficult intubation is with a bronchoscope under local anaesthesia and mild sedation [14,15].…”

Section: Introductionmentioning

confidence: 99%

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

et al. 2015

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SummaryNumerous indirect laryngoscopes have been introduced into clinical practice and their use for tracheal intubation under local anaesthesia has been described. However, a study comparing indirect laryngoscopic vs fibreoptic intubation under local anaesthesia and sedation appears lacking. Therefore, we evaluated both techniques in 100 patients with an anticipated difficult nasal intubation time for intubation the primary outcome. We also assessed success rate, glottic view, Ramsey score, and patients' and anaesthetists' satisfaction. The median (IQR [range]) time for intubation was significantly shorter with the videolaryngoscope with 38 (24-65 [11-420]) s vs 94 (48-323 [19-1020]) s (p < 0.0001). There was no difference in the success rate of intubation (96% for both techniques; p > 0.9999) and satisfaction of the anaesthetists and patients. We conclude that in anticipated difficult nasal intubation a videolaryngoscope represents an acceptable alternative to fibreoptic intubation.

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Section: Introductionmentioning

confidence: 99%

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

et al. 2015

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“…However, primary complications during fiberoptic bronchoscopic tracheal intubation, such as epistaxis, laryngeal trauma, laryngospasm, aspiration, respiratory depression, etc., still trouble doctors and patients [1, 2]. Many kinds of agents are used for decreasing discomfort of patients during awake fiberoptic intubation, including propofol, dexmedetomidine, midazolam, diazepam, meperidine, remifentanil, fentanyl [3–5].…”

Section: Introductionmentioning

confidence: 99%

Clinical application of a novel endoscopic mask: a randomized controlled, multi-center trial in patients undergoing awake fiberoptic bronchoscopic intubation

Zou

Huang

et al. 2017

BMC Anesthesiol

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BackgroundAwake fiberoptic bronchoscopic tracheal intubation is usually regarded as an effective method in the management of predicted difficult airway. Hypoxia during awake nasal fiberoptic bronchoscopic intubation leads to discontinuation of the procedure, prolonged manipulation time and increased risk of severe complications. The main aim of the study was to test whether the novel endoscopic mask is helpful for hypoxia during the intubation.MethodsThis was a randomized, controlled, multi-center study. 55 patients were recruited, but one patient was lost to follow-up. Finally, 54 patients (19 man and 35 women) were analyzed. After entering the operating room, nasal catheter oxygen-providing was given in the control group, and the treatment group received endoscopic mask oxygen-providing, with a flow rate of 3 L/min, lasting into the end of the intubation. Primary outcomes included mean arterial pressure, heart rate, minimum pulse oxygen saturation and incidence of pulse oxygen saturation ≤ 90%. Secondary outcomes included number of intubation attempts and time to intubation. All outcomes were finally measured.ResultsMinimum pulse oxygen saturation during awake nasal fiberoptic bronchoscopic tracheal intubation was significantly higher in the endoscopic mask intubation group (91.7% ± 4.7%) than that the nasal catheter intubation group (87.6% ± 8.2%, P = 0.031. Furthermore, the incidence of pulse oxygen saturation ≤ 90% was significantly lower in the endoscopic mask intubation group (20.0%, 5/25) than that in the nasal catheter intubation group (51.7%, 15/29, P = 0.037). But mean arterial pressure of during intubation was significantly higher in the endoscopic mask group (100.0 ± 13.3 vs 90.3 ± 21.8, P = 0.049). In addition, there were no differences in the number of intubation attempts (P = 0.45) or time to intubation between the two groups (P = 0.38).ConclusionsThe endoscopic mask was safely used in awake fiberoptic bronchoscopic tracheal intubation, with advantages of stable blood pressure and potential prevention of desaturation. Beginners for the intubation procedure and patients at high risk of hypoxia could benefit from the use of the endoscopic mask.Trial registrationTrial registration: www.chictr.org.cn. Registration No.: ChiCTR-TRC-13004086. Date of Registration: 8th, Sep, 2013.

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“…[1] The management of a difficult airway is one of the most challenging task for an anaesthesiologist and fibreoptic intubation is an effective and reliable tool to manage such patients. [2,3] The flexible fibreoptic bronchoscope (FOB) is the most widely used, versatile, indirect laryngoscopy device, which helps in gaining access to difficult airway in routine as well as in an emergency. [3] Awake fibreoptic intubation (AFOI) is indicated in a variety of clinical situations.…”

Section: Introductionmentioning

confidence: 99%

A Study to Compare Efficacy of Two Different Doses of Dexmedetomidine during Awake Nasotracheal Fibreoptic Intubation in Patients with Difficult Airway

Taneja¹,

Puri²,

Gupta³

et al. 2017

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Background: Aim: An ideal awake fibreoptic intubation requires sedation, anxiolysis, amnesia and blunting of airway reflexes while maintaining patent airway with spontaneous ventilation. Dexmedetomidine is a valuable drug for use during fiberoptic intubation as it produces sedation, analgesia and blunting of hemodynamic stress response without depression of respiratory functions. Methods: This is a prospective randomize single blinded study carried out in 80 patients of ASA I -III undergoing oral surgeries with difficult airway. Group L received IV dexmedetomidine in a dose of 0.75µgm/kg body weight over 10 minutes prior to awake nasotracheal fiberoptic intubation. Group H received IV dexmedetomidine in a dose of 1µgm/kg body weight over 10 minutes prior to awake nasotracheal fiberoptic intubation. Results: The mean age, height and weight were comparable in both the groups. Systolic blood pressure in group L was more in group L i.e. 136.38 ± 18.16 mmHg than in group H i.e. 126.93 ±18.16 mmHg just after intubation. Mean arterial pressure was more in group L (100.95 ± 11.46 mmHg) than in group H ( 94.98 ± 12.33 mmHg) just after intubation. Group H had more favourable tolerance score during awake fiberoptic intubation and also the cough score was low in group H as compared to group L. Conclusion: 1 µg/kg of dexmedetomidine showed better ease of intubation, patient tolerance score and cough score during awake fiberoptic intubation as compared with 0.75 µg/kg of dexmedetomidine. But hypotension was seen as a transient effect in higher dose which was not significant.

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Fiberoptic Intubation: An Overview and UpdateDiscussion

Cited by 147 publications

References 118 publications

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

Clinical application of a novel endoscopic mask: a randomized controlled, multi-center trial in patients undergoing awake fiberoptic bronchoscopic intubation

A Study to Compare Efficacy of Two Different Doses of Dexmedetomidine during Awake Nasotracheal Fibreoptic Intubation in Patients with Difficult Airway

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Fiberoptic Intubation: An Overview and UpdateDiscussion

Cited by 147 publications

References 118 publications

Fibreoptic vs videolaryngoscopic (C-MAC®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC®D-BLADE) nasal awake intubation under local anaesthesia

Clinical application of a novel endoscopic mask: a randomized controlled, multi-center trial in patients undergoing awake fiberoptic bronchoscopic intubation

A Study to Compare Efficacy of Two Different Doses of Dexmedetomidine during Awake Nasotracheal Fibreoptic Intubation in Patients with Difficult Airway

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Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia