title: A structured training program for awake fiber optic intubation: teaching the complete package.
abstract: BACKGROUND
  We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices.
  
  
  METHODS
  The training procedure was divided into two sessions: a theoretical session on difficult airways, the fiber optic bronchoscope (FOB), remifentanil, topical anesthesia and patient interactions; and a session involving simulations of the FOI technique on dummies. For in vivo FOI, we enrolled patients requiring orotracheal intubation for elective surgery. Electrocardiograms, mean arterial pressure (MAP) values, peripheral O(2) saturation (SpO(2)) values, respiratory rates (RR) and sedation scores (OAA/S) were acquired. Remifentanil infusion was started at 0.05-0.1 microg*kg(-1)*min(-1), and patients' upper airways were anesthetized with lidocaine. Remifentanil was titrated to achieve an OAA/S of 9-12. FOBs were inserted, and topical laryngeal anesthesia was achieved ("spray as you go" technique). The instrument was passed into the trachea, the OT tube was railroaded over the fiberscope, and tracheal intubation was completed. The procedure duration and patients' vital parameters and satisfaction were recorded.
  
  
  RESULTS
  Three experts and four less-experienced anesthesiologists who performed 29 (10, 10 and 9) and 25 (6, 6, 6 and 7) FOIs, respectively, joined the study. To reach the target OAA/S, the remifentanil dosage was progressively increased to an average dose of 0.15+/-0.05 microg*Kg(-1)*min(-1). MAP and SpO(2) values were stable throughout the procedures, HR was slightly increased (from 77+/-16 to 90+/-23 bpm, P=0.02), and RR was decreased (from 16+/-3 to 12+/-4 bpm, P<0.05). No differences were recorded between the experts and less-experienced anesthesiologists. The average duration of FOI was 3.3+/-2.0 min for experts and 4.2+/-2.4 min for novices (P=0.03). Procedures were successful in both groups, with patients in each group being equally satisfied with the procedures.
  
  
  CONCLUSIONS
  This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.
authors.affiliation: Anesthesia and Intensive Care Department, Hospital of Desio, Desio, Milan, Italy. massiguglielm@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Guglielmi
authors.forename: L
authors.initials: L
authors.lastname: Urbaz
authors.forename: C
authors.initials: C
authors.lastname: Tedesco
authors.forename: A
authors.initials: A
authors.lastname: Pusceddu
authors.forename: A
authors.initials: A
authors.lastname: Sogni
authors.forename: G
authors.initials: G
authors.lastname: Ronzoni
mesh_terms: D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D016292:Procedural Sedation; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D008875:Middle Aged