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GENERAL ARTICLES

Teaching the Use of Fiberoptic Intubation in Anesthetized, Spontaneously Breathing Patients

Department of Anesthesia, University of Basel/Kantonsspital, Basel, Switzerland

Address correspondence and reprint requests to Thomas Erb, MD, Department of Anesthesiology, Duke University Medical Center, PO Box 3094, Durham, NC 27710. Address e-mail to ERB00003 @mc.duke.edu.

In patients with difficult airways, the standard of care involves fiberoptic intubation under spontaneous ventilation. However, the safety and feasibility of a fiberoptic intubation teaching program has only been documented in paralyzed and apneic patients, whereas data obtained in patients under spontaneous respiration are limited and conflicting. We evaluated 100 anesthetized patients undergoing orotracheal fiberoptic intubation. Five anesthesia residents with no prior experience in fiberoptic laryngoscopy participated in the study. In a randomized fashion, each participant tracheally intubated 10 spontaneously breathing patients (Group A: sevoflurane anesthesia via an airway endoscopy mask) and 10 paralyzed patients (Group B: total IV anesthesia with propofol, fentanyl, atracurium). Overall rate of success (96%), defined as successful intubation of the trachea within two attempts, was not different between groups. During fiberoptic intubation, SpO₂ values remained >95% in Group A, whereas SpO₂ decreased to <95% in two patients in Group B. Failure to pass the tube into the trachea over the bronchoscope was encountered in four patients in Group A and in no patient in Group B. Our data suggest that it is safe to teach the use of fiberoptic intubation in anesthetized, spontaneously breathing patients with normal airway anatomy.

Implications: Fiberoptic intubation under spontaneous respiration is a well established technique for management of difficult airways. Our study demonstrates the feasibility and safety of a novice training program for fiberoptic intubation under general anesthesia, not only in paralyzed patients but also in those breathing spontaneously.

This article has been cited by other articles:

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				V. K. Durga, J. P. Millns, and J. E. Smith Manoeuvres used to clear the airway during fibreoptic intubation Br. J. Anaesth., August 1, 2001; 87(2): 207 - 211. [Abstract] [Full Text] [PDF]

				C. M. B. Heard, B. Gunnarsson, and J. E. Fletcher Teaching Fiberoptic Intubation in the Pediatric Patient Anesth. Analg., October 1, 2000; 91(4): 1044 - 1044. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999