title: Nasal versus oral fiberoptic intubation via a cuffed oropharyngeal airway (COPA) during spontaneous ventilation.
abstract: OBJECTIVE
  To compare the success rate of nasal versus oral fiberoptic intubation in anesthetized patients breathing spontaneously via the cuffed oropharyngeal airway (COPAtrade mark).
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Two university-affiliated hospitals.
  
  
  METHODS
  Patients scheduled for general or plastic surgery of the torso or extremities.
  
  
  METHODS
  Nasal (n=20) and oral (n=20) fiberoptic intubation were performed in patients while breathing spontaneously via the COPA during standardized anesthesia.
  
  
  METHODS
  Demographic data, mean arterial pressure, heart rate, end-tidal carbon dioxide (ETCO2), oxygen saturation (SpO2), COPA size, difficult airway predictors, rate of failed ventilation via COPA, and frequency of hypoxemia (SpO2 < 90%) during the procedure, and perioperative untoward events were recorded.
  
  
  RESULTS
  The background, airway difficulty, vital signs and untoward effects were similar in the two groups. Nasal fiberoptic laryngeal view (scale 1-4) was better than the oral grading (3 [median] vs. 2, respectively; p <0.05). Eighty percent of the nasal intubations were successful compared with 40% of the oral intubations (p <0.05). Nasal intubations were accomplished within 153 +/- 15 SD seconds compared with 236 +/- 22 seconds (p <0.05) for the oral intubations, and less propofol was needed in the nasal intubations during the procedures (240 +/- 27 mg [nasal] vs. 277+/- 39 mg [oral]; p <0.05).
  
  
  CONCLUSIONS
  Nasal fiberoptic laryngoscopy is more successful and easy than the oral approach in anesthetized patients who are breathing spontaneously through the COPA.
authors.affiliation: Department of Anesthesia and Plastic Surgery Unit, Wolfson Medical Center, Holon, Israel.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.forename: Peter
authors.initials: P
authors.lastname: Szmuk
authors.forename: Shmuel
authors.initials: S
authors.lastname: Evron
authors.forename: Robert D
authors.initials: RD
authors.lastname: Warters
authors.forename: Oscar
authors.initials: O
authors.lastname: Herman
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000768:Anesthesia, General; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009960:Oropharynx; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D019651:Plastic Surgery Procedures