title: A comparison of Bonfils intubation fiberscopy and fiberoptic bronchoscopy in difficult airways assisted with direct laryngoscopy.
abstract: BACKGROUND
  To evaluate the usefulness of Bonfils intubation fiberscope assisted by direct laryngoscopy (BIF-DL) and flexible fiberoptic bronchoscope assisted by direct laryngoscopy (FOB-DL) using video recording in cases of unanticipated difficult intubation with respect to the time required to visualize the vocal cords and place the endotracheal tube. We compared two fiberscopes in patients with authentic difficult airways.
  
  
  METHODS
  In this randomized, controlled clinical trial, 40 patients (grade 3 according to grades of difficulty in laryngoscopy), scheduled for surgery under general anesthesia were randomly allocated to BIF-DL group or FOB-DL group. Number of attempts, time required for visualization of the vocal cord (T1) and placement of the endotracheal tube (T2) from insertion of instrument during the last successful attempt, and duration of scope manipulation during all attempts (T(total)) were recorded. If intubation failed with one method, the other method was tried; these cases were then excluded. The incidence of sore throat and hoarseness was assessed.
  
  
  RESULTS
  T1, T2, and T(total) were significantly shorter in BIF-DL group (T1: 21.9 +/- 8.2 sec vs. 80.4 +/- 29.9 sec, P < 0.001, T(total): 77.9 +/- 41.2 sec vs. 145.5 +/- 83.9 sec, P = 0.003). In two cases, it was impossible to intubate with BIF-DL, but the procedure was subsequently successful using fibreoptic bronchoscope.
  
  
  CONCLUSIONS
  Intubation of difficult airways can be performed more rapidly with BIF-DL, but sometimes it may not be possible to intubate with the scope.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Woo
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim