Time to abandon awake fibreoptic intubation?

Current practice for awake fibreoptic intubation - asking the right questions

“…As El-Boghdadly et al and Murphy and Howes [3] observe, training in AFOI is advisable for all anaesthesia trainees, and their study's detailing of the grades of trainee performing AFOI, together with their complication rates, is a useful addition to the literature. Our own 2015 retrospective study of 1554 AFOIs, also at a tertiary care teaching centre, included AFOIs performed by attending consulting staff or their trainees under supervision [4], as did Joseph et al's retrospective analysis of AFOI, in which specific mention was made of resident involvement in 1038 of the 1085 cases reported [5].…”

“…Murphy and Howes cite an editorial [3] written by one of our authors. Our prospective study (rather than audit, as there are no accepted standards) has demonstrated that AFOI is associated with low morbidity and a high success rate, particularly when appropriate training is undertaken.…”

“…Had Drs. Murphy and Howes put Ahmad and Bailey's editorial into context [3], they would have understood that training is recommended for AFOI, and when not undertaken, AFOI should be considered a specialist skill. Performed by appropriately trained and competent clinicians, the utility of a technique that has been part of anaesthetic practice for 50 years is difficult to refute.…”

Experience in awake fibreoptic intubation: a reply

“…Obtaining and maintaining competence in the procedural skill of awake VL is readily achievable, as the technique is more similar to the asleep approach than FB and therefore more readily practiced. It is pertinent to remember that a myriad of videolaryngoscopes exist, and proficiency in one type does not guarantee proficiency in another [4]. Furthermore, VL will still fall short compared with FB in cases with limited mouth opening, hence practice in the latter should still be encouraged.…”

Time to stand up for fibreoptic intubation

“…The recent papers by Lee et al. and Ahmad and Bailey discredit fibreoptic intubation. I think such criticism is not justified for several reasons.…”