Continuous ventilation during intubation through a supraglottic airway device guided by fiberoptic bronchoscopy: a observational assessment.
BACKGROUND
supraglottic airway devices remain, despite advances in video laryngoscopy, important tools in the management of unexpected difficult airways. Intubation through a functioning supraglottic airway device with the aid of a fiberoptic bronchoscope is a well-known technique usually performed in apnoea. With a simple modification, the patient can be ventilated during this procedure.


METHODS
In this observational study, Tracheal intubation Assisted by Bronchoscopy And Sad during Continuous Oxygenation (TABASCO) was performed as part of department training routine in 26 elective, fasted patients. A supraglottic airway device was used as a conduit for an endotracheal tube.


RESULTS
All patients were easily intubated and ventilation was maintained during the procedure. The gap between the outer diameter of the fiberoptic bronchoscope and the inner diameter of the endotracheal tube was more than 2 mm in 25 of 26 patients. Effective ventilation was confirmed by clinical signs, capnography and pressure-volume curves. No signs of airtrapping occurred.


CONCLUSIONS
No adverse events were observed during this form of airway management in this small series of elective and fasted patient when performed by an anaesthesiologist experienced in fiberoptic intubation. A gap between fiberoptic bronchoscope and endotracheal tube inner lumen seems to be prerequisite for easy ventilation through the supraglottic airway. In trained hands, this technique can be a means to secure an airway with an intubating bronchoscope without pausing ventilations. A prerequisite for this is a well-functioning supraglottic airway device.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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HE
Landsdalen
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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M
Berge
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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F
Kristensen
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.|University of Bergen, Bergen, Norway.
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Guttormsen
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
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E
Søfteland
D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D012121:Respiration, Artificial