title: Bonfils intubation fibrescope: use in simulation-based intubation training for medical students in comparison to MacIntosh laryngoscope.
abstract: BACKGROUND
  A variety of instruments are used to perform airway management by tracheal intubation. In this study, we compared the MacIntosh balde (MB) laryngoscope with the Bonfils intubation fibrescope as intubation techniques. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. Data were collected from 150 participants using an airway simulator ['Laerdal Airway Management Trainer' (Laerdal Medical AS, Stavanger, Norway)]. The participants were randomly assigned to a sequence of techniques to use. Four consecutive intubation 'trials' were performed with each technique. These trials were evaluated for differences in the following categories: the 'time to successful ventilation', 'success probability' within 90 s,'time to visualisation' of the vocal cords (glottis), and 'quality of visualisation' according to the Cormack and Lehane score (C&L, grade 1-4). The primary endpoint was the 'time to successful ventilation'in the fourth and final trial.
  
  
  RESULTS
  There was no statistically significant difference in the 'time to successful ventilation' between the two techniques in trial 4 ('time to successful ventilation': median: MB: 16 s, Bonfils: 14 s, p = 0.244). However, the 'success probability' within 90 s was higher when using a Macintosh blade than when using a Bonfils (95 vs. 87%). The glottis could be better visualised when using a Bonfils (C&L score of 1 (best view): MB: 41%, Bonfils: 93%), but visualisation was achieved more rapidly when using a Macintosh blade (median: 'time to visualisation': MB: 6 s, Bonfils: 8 s, p = 0.003).
  
  
  CONCLUSIONS
  The time to ventilation using the MacIntosh blade and Bonfils mainly did to differ, however success probabilities and time to visualisation primary favoured the MacIntosh blade as intubation technique, although the Bonfils seem to have a steeper learning curve. The Bonfils is still a promising intubation technique and might be easier to learn as the MB, at least in a manikin.
authors.affiliation: Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany. tobias.limbach@uni-mainz.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Limbach
authors.affiliation: Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany. ottth@uni-mainz.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ott
authors.affiliation: Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany. griesing@uni-mainz.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Griesinger
authors.affiliation: Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany. jahna@uni-mainz.de.
authors.forename: Antje
authors.initials: A
authors.lastname: Jahn-Eimermacher
authors.affiliation: Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany. piepho@uni-mainz.de.
authors.forename: Tim
authors.initials: T
authors.lastname: Piepho
mesh_terms: D000328:Adult; D004521:Educational Measurement / Q000706:statistics & numerical data*; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D008297:Male; D008348:Manikins; D011231:Preceptorship; D012121:Respiration, Artificial; D000066908:Simulation Training / Q000706:statistics & numerical data*; D013337:Students, Medical; D013997:Time Factors