When the Endotracheal Tube Will Not Pass over the Flexible Fiberoptic Bronchoscope

Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation

“…In accordance, the present study showed that the incidence of impingement of the tube, and of failed intubation, was lower with an instrument with a thicker insertion cord. Schwartz et al [2] and Katsnelson et al [4] showed that the intubation tube can become impacted on the right arytenoid cartilage. In the study by Schwartz et al [2] successful intubation was Anaesthesia, Volume 50, August 1995 n, the consecutive number of the patient in the study.…”

Basic airway management by junior doctors

“…The conclusion of the study was that the most common site of impingement is the right arytenoid cartilage, as shown for orotracheal fibreoptic intubation [2]. All 10 cases of tracheal tube impingement in this study were overcome by rotation of the tube, although in seven of these cases, this required three or more passes of the tube.…”

“…There is a greater incidence of complications such as desaturation, laryngospasm, airway obstruction and vomiting during tracheal extubation than intubation [1,2]. Despite this, competencies for tracheal extubation do not exist and trainees are not formally assessed.…”

Fibreoptic intubation

“…On advancing the endotracheal tube over the scope the leading edge may impact on the epiglottis because with the nasal approach the tube tends to move anteriorly relative to the scope. 65 Orienting the tube such that the bevel faces anteriorly or advancing the tube with a rotating or twisting motion may facilitate laryngeal entry. 22,24,26,65 The temporary insertion of a soft lubricated nasopharyngeal airway into the nose before subsequent insertion of the endotracheal tube permits exploration of the nasal cavity such than an approximately sized tube can be chosen, 15 produces further decompression of the nasal mucosa, 67 and may reduce trauma due to the more rigid endotracheal tube.…”

“…65 Orienting the tube such that the bevel faces anteriorly or advancing the tube with a rotating or twisting motion may facilitate laryngeal entry. 22,24,26,65 The temporary insertion of a soft lubricated nasopharyngeal airway into the nose before subsequent insertion of the endotracheal tube permits exploration of the nasal cavity such than an approximately sized tube can be chosen, 15 produces further decompression of the nasal mucosa, 67 and may reduce trauma due to the more rigid endotracheal tube. 29 A nasopharyngeal airway slit longitudinally can be used as a guide through which the bronclioscope can be passed, and then removed before subsequent passage of the endotracheal tube.68 Alternatively the bronchoscope can be passed through the nose and on into the trachea under fibreoptic control before the endotracheal tube is inserted.…”