SummaryWe Key wordsIntubation, tracheal; technique, training. Equipment; laryngoscope, fibreoptic.Fibreoptic intubation is now established as a safe and reliable technique for the management of many patients who present difficulties with tracheal intubation [I]. The acquisition of skill in fibreoptic airway endoscopy is recognised as an essential part of every anaesthetist's training (2, 31. However, it often proves to be a difficult and time consuming skill to learn, especially if inherent difficulties are compounded by either a shortage of experienced trainers or of formal training programmes or both [4, 51. In the United Kingdom, anaesthetists are often taught on anaesthetised patients. One of the criticisms of this type of training is that it does not prepare the trainee for some of the problems likely to be encountered during awake fibreoptic intubation, which is often the treatment of choice for difficult intubation [6]. It has recently been suggested that preliminary training with the nasendoscope in ear, nose and throat (ENT) outpatient clinics, may be a good way of learning fibreoptic skills [7]. It has the additional advantage of providing experience in the management of awake patients during endoscopy. This study was designed to compare the progress of anaesthetists trained in ENT outpatient clinics with those trained using traditional methods. MethodsThe study was approved by the ethics committee of the South Birmingham Health District. Twelve anaesthetists of varying grades and with no previous experience in fibreoptic techniques took part.Preliminary training. The functions and operation of the Olympus LF-1 fibreoptic laryngoscope were demonstrated to all anaesthetists. They received written instructions on how to perform fibreoptic intubation and discussed common problems and pitfalls with the instructors. Each anaesthetist then had a structured training session on a Laerdal bronchial tree model. Trainees were asked to demonstrate the main features of bronchial anatomy and were required t o manipulate the fibrescope into specific segmental bronchi selected by the instructor. The purpose of these exercises was to assist the trainee in understanding how to the control fibrescope movements.Participants were then paired for age and professional status and randomly allocated to receive fibreoptic training on ENT outpatients (ENT group) or on anaesthetised oral surgery in-patients (traditional group).Endoscopy training. Each trainee in the ENT group attended the ENT outpatient clinic in turn and performed ten nasendoscopies under the supervision of a consultant ENT surgeon. Nasendoscopies were only performed on patients requiring this investigation as part of their clinical management. The patient's nose and nasopharynx were anaesthetised with topical cocaine and the patient was positioned so that heishe was sitting upright with the anaesthetist facing him/her. The nasendoscope was then introduced into the nose, nasopharynx and pharynx and laryngoscopy was performed. The trainee was required

SummaryWe have investigated the extent to which the laryngeal mask airway, when used as an aid to fibreoptic nasotracheal video-endoscopy training, could reduce endoscopy apnoeic time in anaesthetised, paralysed oral surgery patients. Twenty anaesthetic trainees were randomly allocated to the laryngeal mask airway or control group. Laryngeal mask airway group endoscopies were performed in three stages following insertion of the laryngeal mask airway: stage 1: nasendoscopy, with the lungs ventilated automatically through the laryngeal mask airway; stage 2: removal of the laryngeal mask airway; stage 3: pharyngoscopy, larygoscopy and tracheoscopy. Control group endoscopies were performed conventionally, in one stage. Each trainee performed five nasotracheal intubations. Though total endoscopy time in the laryngeal mask airway group (stage 1 þ stage 2 þ stage 3 times) was significantly longer (average 136 s vs. 108 s), apnoeic time (stage 2 þ stage 3 times) was significantly shorter (average 59 s vs. 108 s) than endoscopy time in the control group. This application of the laryngeal mask airway may have a useful role to play in ensuring patient safety during early fibreoptic training.

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