title: A randomized controlled comparison of the Bonfils fiberscope and the GlideScope Cobalt AVL video laryngoscope for visualization of the larynx and intubation of the trachea in infants and small children with normal airways.
abstract: BACKGROUND
  The Bonfils fiberscope (BF) used without the assistance of a laryngoscope failed to improve the view of direct laryngoscopy in children with normal airways. We hypothesized that if BF is supported by a laryngoscope--as recommended by its inventor--it can provide comparably good visualization of the glottis as the GlideScope(®) Cobalt AVL video laryngoscope (GS).
  
  
  METHODS
  We included 100 children with normal airways in a randomized controlled trial. The study consisted of assessing the airway by direct laryngoscopy (DL), followed by intubation using either the BF or the GlideScope. Main outcome measures were the quality of visualization of the larynx by the percentage of glottis opening seen (POGO) and the time needed for intubation of the trachea.
  
  
  RESULTS
  Visualization of the larynx (POGO) using the BF was significantly better than with DL (P = 0.016) or with GS (P = 0.001). The DL provided an allover better visualization than GS, although this difference was not significant and solely attributable to children weighing <15 kg. Intubation was successful in all cases with both devices. The time needed for intubation was shorter using the BF (36 ± 8 s) than with the GlideScope (49 ± 12 s, P < 0.001).
  
  
  CONCLUSIONS
  The Bonfils fiberscope significantly improved the view on the larynx compared with direct laryngoscopy and the GlideScope and enables shorter intubation time than with the GlideScope.
authors.affiliation: Department of Pediatric Anesthesiology, Children's Hospital of Cologne, Cologne, Germany. kaufmannj@kliniken-koeln.de
authors.forename: Jost
authors.initials: J
authors.lastname: Kaufmann
authors.forename: Michael
authors.initials: M
authors.lastname: Laschat
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
mesh_terms: D058109:Airway Management / Q000295:instrumentation / Q000379:methods; D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D020704:Laryngoscopes / Q000009:adverse effects; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D007830:Larynx / Q000033:anatomy & histology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D018401:Sample Size; D016896:Treatment Outcome; D014741:Video Recording
keywords: airway; children; equipment; infants; intubation; laryngoscope