title: Advancing the tracheal tube over a flexible fiberoptic bronchoscope by a sleeve mounted on the insertion cord.
abstract: The advancement of an endotracheal tube (ETT) over a flexible fiberoptic bronchoscope (FOB) is often impeded at the glottis. This is attributed to the creation of a cleft by the difference in the outer diameter of the fiberscope and the internal diameter of the tube. We designed a conical-shaped polyvinyl chloride sleeve to fit the insertion cord. This report compares the ease of advancement of the tube over a sleeved versus a nonsleeved bronchoscope. General anesthesia was induced, and one anesthesiologist introduced the FOB (a 3.8-mm Olympus LF2). Patients were randomly assigned to undergo tracheal intubation with the regular bronchoscope (25 patients) or the sleeved bronchoscope (25 patients). The FOB was advanced to approximately 1 cm above the carina. A blinded operator advanced the tube over the bronchoscope. The ETT was successfully advanced over the nonsleeved bronchoscope into the trachea on the first attempt in 64% of the patients, whereas tracheal intubation succeeded from the first attempt in 96% of patients when the sleeved FOB was used (P < 0.05). Advancement of the ETT over the fiberscope can be facilitated by using a conically shaped sleeve mounted on the insertion cord.
  
  
  CONCLUSIONS
  This report shows that a conical sleeve mounted on the insertion cord of a fiberoptic bronchoscope will facilitate advancing the endotracheal tube into the trachea.
authors.affiliation: Department of Anesthesiology, American University of Beirut Medical Center, Lebanon. ayoub@aub.edu.lb
authors.forename: Chakib M
authors.initials: CM
authors.lastname: Ayoub
authors.forename: Marwan S
authors.initials: MS
authors.lastname: Rizk
authors.forename: Chadi I
authors.initials: CI
authors.lastname: Yaacoub
authors.forename: Anis S
authors.initials: AS
authors.lastname: Baraka
authors.forename: Antoine M
authors.initials: AM
authors.lastname: Lteif
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged