The skill of tracheal intubation with rigid scopes – a randomised controlled trial comparing learning curves in 740 intubations

Abstract

Background Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established. Methods This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per physician) in adult patients without predictors of a difficult airway under general anaesthesia. According to randomisation, physicians intubated the patient’s trachea with either the Bonfils or the SensaScope. A maximum of three intubation attempts was allowed. Primary outcome was overall time to successful intubation. Secondary outcome parameters included first attempt success, first attempt success within 60 s, failures and adverse events. Results A clear learning effect was demonstrated: Over 20 trials, intubations became 2.5-times quicker and first attempt intubation success probability increased by 21–28 percentage points. Fourteen and 20 trials were needed with the Bonfils and the SensaScope, respectively, to reach a 90% first attempt success probability. Intubation times were 23% longer (geometric mean ratio 1.23, 95% confidence interval 1.12–1.36, p < 0.001) and first attempt success was less likely (odds ratio 0.64, 95% confidence interval 0.45–0.92, p = 0.016) with the SensaScope. Consultants showed a tendency for a better first attempt success compared to registrars. Overall, 23 intubations (10 Bonfils, 13 SensaScope) failed. Adverse events were rare and did not differ between devices. Conclusions A clear learning effect was demonstrated for both rigid scopes. Fourteen intubations with the Bonfils and 20 intubations with the SensaScope were required to reach a 90% first attempt success probability. Learning of the technique seemed more complex with the SensaScope compared to the Bonfils. Trial registration Current Controlled Trials, ISRCTN14429285. Registered 28 September 2011, retrospectively registered.

Acute Emphysematous Epiglottitis: A Case Report

“…We used a rigid endoscope to exchange the nasotracheal tube for a larger oral endotracheal tube using the Seldinger technique because of the excellent visualization and control it offers as a stylet, which has been well described in the pediatric literature 4 . Others have utilized rigid endoscopes simply to aid in airway visualization during difficult intubations 5 . We advocate for having rigid endoscopes available in the OR for potentially difficult airway scenarios.…”

“…4 Others have utilized rigid endoscopes simply to aid in airway visualization during difficult intubations. 5 We advocate for having rigid endoscopes available in the OR for potentially difficult airway scenarios. They are a versatile tool that could be a life-saving alternative during a difficult intubation prior to resorting to an emergency surgical airway.…”

Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report

“…It is important to know whether styletubation, when used by novices of airway management, is effective in both normal and difficult airway scenarios [84][85][86]. In mannequin studies, styletubation provided faster, easier, and less traumatic intubation than the DL or VL [87][88][89][90][91].…”

An Approach to Improve the Effectiveness of the Video-Assisted Intubating Stylet Technique for Tracheal Intubation: A Case Series Report

“…Similar to the Bonfils intubation endoscope and fiberoptic scopes [ 24 , 25 ], the VS technique can be encumbered by copious secretions, blood, or vomitus in the airway ( Figure 1 C,D). These secretions and mucus have to be carefully removed via suctioning to improve the visualization of the airway anatomy.…”