Fibreoptic intubation in airway management: a review article

Abstract

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

A new self-designed “tongue root holder” device to aid fiberoptic intubation

“…In recent years, many devices have been invented to help anesthesiologists overcome difficult airway management. Video-assisted laryngoscope and laryngeal mask airway help us greatly, whereas the fiberoptic bronchoscope maintains its important role or is used as a rescue approach in failed attempts [ 2 – 4 ].…”

Video laryngoscopy in COVID-19 patients: a word of caution

“…A method that similarly increases the distance between the patient and operator is flexible bronchoscopic intubation (by experienced operators) under anesthesia with deep muscle relaxation. 3 We would also like to emphasize that if a video laryngoscope is used, it is preferential not to use its integrated oxygen channel if present (APA Oxy Blade TM ; Venner Medical Pte Ltd, Singapore) as the extraneous flow of oxygen may increase aerosol generation rather than reduce it. Nor should stylets or flexible bronchoscopes have oxygen insufflated through their central channels.…”

Disruptive innovators in anaesthesia: data and devices

“…In another variation of technological enhancement in anaesthetic practices, the use of newer airway devices has increasingly helped to avert morbidity and mortality in-and outside of operating theatres. Wong et al (7) presented a comprehensive review of a topic that is close to the heart of many anaesthetists. Every anaesthetist would have had an unforgettable 'airway patient' or airway-related near miss.…”

“…The advent of supraglottic airway devices has saved many lives over the years; (8) the preponderance of videolaryngoscopes and flexible fibreoptic bronchoscopes has helped to intubate many difficult tracheas. In their article, Wong et al (7) discussed the indications, contraindications, limitations and complications associated with fibreoptic bronchoscopy. Importantly, they made references to recent airway algorithms (from the United Kingdom's Difficult Airway Society and the American Society of Anesthesiologists) (9) and the 4th National Audit Project from the United Kingdom's Royal College of Anaesthetists on major airway complications.…”

“…(10) Pathways developed by difficult airway societies help to anchor the thought processes of a worried and harried anaesthetist to well-tested algorithms, helping them to make critical airway management decisions rapidly, safely and unequivocally. Wong et al (7) described various patient groups whose airways can be particularly challenging to the anaesthetist and made suggestions for their management with the aid of fibreoptic…”