The performance of rigid scopes for tracheal intubation: a randomised, controlled trial in patients with a simulated difficult airway.
We compared the Bonfils™and SensaScope™rigid fibreoptic scopes in 200 patients with a simulated difficult airway randomised to one of the two devices. A cervical collar inhibited neck movement and reduced mouth opening to a mean (SD) of 23 (3) mm. The primary outcome parameter was overall success of tracheal intubation; secondary outcomes included first-attempt success, intubation times, difficulty of intubation, fibreoptic view and side-effects. The mean (95% CI) overall success rate was 88 (80-94)% for the Bonfils and 89 (81-94)% for the SensaScope (p = 0.83). First-attempt intubation success rates were 63 (53-72)% for the Bonfils and 72 (62-81)% for the SensaScope (p = 0.17). Median (IQR [range]) intubation time was significantly shorter with the SensaScope (34 (20-84 [5-240]) s vs. 45 (25-134 [12-230]) s), and fibreoptic view was significantly better with the SensaScope (full view of the glottis in 79% with the SensaScope vs. 61% with the Bonfils). This might be explained by its steerable tip and the S-formed shape, contributing to better manoeuvrability. There were no differences in the difficulty of intubation or side-effects.
Department of Perioperative Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK.|Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
M
M
Kleine-Brueggeney
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
R
R
Greif
Department of Internal Medicine, Spitalzentrum Oberwallis, Brig, Switzerland.
N
N
Urwyler
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
B
B
Wirthmüller
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
L
L
Theiler
D000328:Adult; D000368:Aged; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D020704:Laryngoscopes / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
cervical fracture: intubation techniques; difficult airway algorithm; failed intubation: treatment; rigid fibreoptic scopes; simulated difficult airway