title: A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation.
abstract: We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml(-1) and midazolam. The airway was anaesthetised with lidocaine spray and gargle. The total procedure time - a composite of sedation time, topical anaesthesia time and intubation time - was recorded. The operator's impression of the ease of the procedure and the patients' reported comfort were recorded on a 0-100 mm visual analogue scale. The median (IQR [range]) for total procedure time was 900 (739-1059 [616-1215]) s with the fibrescope and 651 (601-720 [498-900]) s with the Pentax Airway Scope (p = 0.0001). The median (IQR [range]) intubation time was 420 (283-480 [120-608]) s with the fibrescope and 183 (144-220 [107-420]) s with the Pentax Airway Scope (p = 0.0002). The median (IQR [range]) visual analogue scores for the operator's ease of intubation for the fibrescope and Pentax Airway Scope were 83.6 (72.0-98.0 [49.0-100.0]) and 86.8 (84.0-91.0 [61.0-100.0]), respectively (p = 0.3507). The median (IQR [range]) visual analogue score for patient comfort was 85.5 (81.0-97.0 [69.0-100.0]) and 79.4 (74.0-85.0 [59.0-100.0]) for the fibrescope and Pentax Airway Scope, respectively (p = 0.06). Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.
authors.affiliation: Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: C
authors.initials: C
authors.lastname: Mendonca
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mesbah
authors.affiliation: Department of Anaesthesia, Heart of England Foundation NHS Foundation Trust, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Velayudhan
authors.affiliation: Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: R
authors.initials: R
authors.lastname: Danha
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D008297:Male; D008874:Midazolam / Q000494:pharmacology; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology; D000077208:Remifentanil; D013997:Time Factors; D064232:Visual Analog Scale; D014851:Wakefulness
chemical_list: D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam
keywords: awake intubation; fibreoptic intubation; videolaryngoscopy