title: Evaluation of simple pre-determined length insertion technique (SPLIT) with conventional method for oral fibreoptic intubation: A randomised cross-over study.
abstract: OBJECTIVE
  The difficulty during flexible fiber-optic bronchoscopy (FOB) guided tracheal intubation could be because of inability in visualising glottis, advancing and railroading of endotracheal tube. Several methods are available for visualising glottis, but none is ideal. Hence, this randomised controlled study was designed to evaluate the simple pre-determined length insertion technique (SPLIT) during oral FOB.
  
  
  METHODS
  Fifty-eight patients were randomised into Group C and Group P. General anaesthesia was maintained with sevoflurane and oxygen in spontaneous respiration. In Group C, conventional flexible fiberoptic laryngoscopy was done followed by SPLIT and vice versa in Group P. The time to visualise the glottis (T1), from glottic visualisation to pass beyond glottis (T2) and from incisors to pass beyond the glottis (T3) were noted from the recorded video. The time interval was analysed using Wilcoxon matched pairs test and Mann-Whitney U-test.
  
  
  RESULTS
  The T1was significantly less in SPLIT as compared to conventional technique (13 [10, 20.25] vs. 33 [22, 48] s). The T3was significantly less in SPLIT (24.5 [19.75, 30] vs. 44 [34, 61.25] s). The T1by SPLIT was comparable between residents and consultants (P= 0.09), whereas it was significantly more among residents than the conventional technique. The SPLIT was preferred by 91.3% anaesthesiologists.
  
  
  CONCLUSIONS
  The SPLIT significantly lessened the time to visualise the glottis than conventional technique for FOB. The SPLIT was the preferred technique. Hence, we suggest using the SPLIT to secure the airway at the earliest and also as an alternative to conventional technique.
authors.affiliation: Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Elangovan
authors.initials: E
authors.lastname: Muthukumar
authors.affiliation: Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Lenin Babu
authors.initials: LB
authors.lastname: Elakkumanan
authors.affiliation: Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Prasanna Udupi
authors.initials: PU
authors.lastname: Bidkar
authors.affiliation: Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Mvs
authors.initials: M
authors.lastname: Satyaprakash
authors.affiliation: Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.
authors.forename: Sandeep Kumar
authors.initials: SK
authors.lastname: Mishra
keywords: Fiberoptic intubation; intubation techniques; tracheal intubation