Article

A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study.

Department of Pediatric Anesthesia, IWK Health Centre, Halifax, NS, Canada.
Pediatric Anesthesia (impact factor: 2.1). 04/2010; 20(6):559-65. DOI:10.1111/j.1460-9592.2010.03298.x pp.559-65
Source: PubMed

ABSTRACT Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway.
Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate.
A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult.
The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.

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    Article: Bonfils fiberscope: intubating conditions and hemodynamic changes without neuromuscular blockade.
    Atabak Najafi, Eiman Rahimi, Reza Shariat Moharari, Zahid Hussain Khan
    [show abstract] [hide abstract]
    ABSTRACT: To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs). METHODS: In this randomized controlled trial,80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg(-1) was administered, followed by intravenous alfentanil 20 µg.kg(-1), lidocaine 1.0 mg.kg(-1), and propofol 2 mg.kg(-1) sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465). Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P<0.001). Although mean arterial blood pressure increased immediately after intubation in the Macintosh group (P=0.022), its post-intubation values were significantly less than baseline in both groups (P<0.001). Intubation time took much longer in the Bonfils group (40 s) than the Macintosh group (11 s), P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time.
    Acta medica Iranica 04/2011; 49(4):201-7.
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Keywords

150 intubations
 
Bonfils fiberscope-assisted laryngoscopy
 
Bonfils fibrescope
 
Cormack-Lehane grade 3B view
 
Correct ETT placement
 
difficult airway configuration
 
Difficult airway management
 
gold standard
 
group DL-Difficult
 
group DL-Normal
 
Miller 1 blade
 
Miller-1 blade
 
participant intubated
 
POGO score
 
Primary outcomes
 
simulated difficult infant airway
 
STORZ Bonfils fiberscope
 
styletted 3.5 endotracheal tube
 
styletted 3.5 ETT
 
unaltered manikin
 

Arnim Vlatten