Tracheal intubation using the Bonfils intubation fibrescope after failed direct laryngoscopy*

Abstract

SummaryFailed tracheal intubation due to a difficult airway is an important cause of anaesthetic morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for tracheal intubation after failed direct laryngoscopy. Twenty-five patients undergoing coronary artery bypass grafting were enrolled in the study after two attempts at conventional laryngoscopy by a board certified anaesthetist had failed. Intubation with the Bonfils fibrescope was successful on the first attempt in 22 patients (88%) and on the first or second attempt in 24 patients (96%); in one patient intubation was impossible. Median (IQR [range]) time to intubation using the Bonfils intubation fibrescope was 47.5 (30-80 [20-200]) s. Tracheal intubation using the Bonfils intubation fibrescope appears to be a simple and effective technique for the management of a difficult intubation.

Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway

“…However, in contrast to Bein et al, 7 who reported a 100% success rate in endotracheal intubation using the Bonfils intubation fiberscope, 7 success was achieved in 82% of patients in our study. In another investigation, Bein et al 6 observed that endotracheal intubation was successful in 96% of patients, when the Bonfils intubation fibrescope is used in patients with an unanticipated difficult airway, after direct laryngoscopy had failed. 6 The main reason for intubation failure with the Bonfils intubation fibrescope in our study was most likely due to an inability to direct the rigid device underneath the epiglottis, despite the application of external laryngeal pressure.…”

“…In another investigation, Bein et al 6 observed that endotracheal intubation was successful in 96% of patients, when the Bonfils intubation fibrescope is used in patients with an unanticipated difficult airway, after direct laryngoscopy had failed. 6 The main reason for intubation failure with the Bonfils intubation fibrescope in our study was most likely due to an inability to direct the rigid device underneath the epiglottis, despite the application of external laryngeal pressure. Since the patients' heads were fixed in a neutral position, it remains speculative as to whether or not endotracheal intubation would have been successful with a certain degree of atlantooccipital joint mobility.…”

“…3,4 Devices which apply the principle of indirect visualization of the laryngeal structures include the GlideScope® (Verathon Inc., Bothell, WA, USA), a video laryngoscope with a digital camera located at the blade tip, and a small, separate LCD-monitor connected to the laryngoscope handle with a short cable. 3,4 The rigid Bonfils® intubation fibrescope (Karl Storz GmbH and Co. KG, Tuttlingen, Germany), 5 which has been shown to be effective for difficult airway management, 6 allows visualization of the glottic aperture and the trachea, and thus endotracheal tube placement under vision. Although the efficacy of the Bonfils intubation fibrescope has been demonstrated in patients with anticipated difficult airway based on predictors, 7 its use has not been prospectively evaluated in patients with documented difficult airways.…”

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

“…Devices such as the Bonfils intubation fibrescope and the Shikani Optical stylet have been available for clinical use for a number of years. Although there are case reports and case series documenting efficacy of these devices in management of both routine and difficult airways [3,5,17,[25][26][27][28][29], large comparative studies assessing their efficacy compared with alternative airway devices are lacking. Two studies [30,31] have compared the optical scopes (LFPS and the Shikani optical stylet) with the bougie.…”

S1 guidelines on airway management

“…Rigid intubation endoscopes represent one alternative for intubation of unexpected difficult airways [44,45]. In order to successfully employ these instruments in emergency situations, sufficient experience is needed in patients with a normal airway [46].…”