A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)<sup>®</sup>for awake oral tracheal intubation

Mendonca, Cyprian; Mesbah, Abeer; Velayudhan, Akilan; Danha, R. F.

doi:10.1111/anae.13516

Cited by 39 publications

(59 citation statements)

References 29 publications

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“…effective anxiolysis while the patient remains alert to their surroundings) perhaps highlights the benefits that target‐controlled remifentanil infusions have provided in the management of these patients. All studies used topical lidocaine on the airway, adopting a range of techniques including: transtracheal injection ; nebulised lidocaine ; ‘spray as you go’ metered lidocaine spray and the ‘Mackenzie technique’ . In this, lidocaine is injected into the side port of a standard intravenous cannula, directed into the airway through the mouth and connected to a supply of oxygen which then deposits the drug on the mucosa of the airway.…”

Section: Technical Detailsmentioning

confidence: 99%

The emerging role of awake videolaryngoscopy in airway management

Wilson

Smith

2018

Anaesthesia

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This editorial accompanies an article by Alhomary et al., Anaesthesia 2018; 73: 1151-61. Awake fibreoptic intubation has been considered the technique of choice when managing many types of predicted difficult airway. In principle, if a patient is maintaining the patency of their own airway, there is a margin of safety which is lost if general anaesthesia is induced before the trachea is intubated. Despite this, the Fourth National Audit Project of the Royal College of Anaesthetists (NAP4) reported that awake fibreoptic intubation was not used as the primary airway plan for many highrisk patients [1]. However, awake fibreoptic intubation is a complex skill requiring regular practice to maintain competence. It is easy to see how this potentially difficult task, performed on a high-risk patient group, in departments where numbers of awake fibreoptic intubations may be low, may pose a problem; and in consequence, it is understandable that an anaesthetist might opt for a more familiar, but less appropriate, technique [1]. It is of course also true that awake fibreoptic intubation is not suitable for tracheal intubation in all patients with airway problems, and it is not always successful; NAP4 demonstrated that it failed for a variety of reasons. Most commonly these were airway obstruction, lack of patient co-operation and difficulty recognising airway anatomy due to excess secretions, blood or suction failure [1]. Changing practiceThe NAP4 was published in 2011. However, anaesthetic practice is ever changing. In 2016, Ahmad and Bailey argued in this journal that awake fibreoptic intubation was becoming obsolete [2]. Later that year, reviewing the revised Difficulty Airway Society's (DAS) guidelines on difficulties in intubation, Marshall and Pandit suggested that "if it is essential to maximise the first attempt success rate, and if it is the case that videolaryngoscopes yield higher success in visualising the glottis, then it follows that these should become first-line devices in most if not all tracheal intubations" [3]. A Cochrane systematic review of videolaryngoscopy compared with direct laryngoscopy in adults concluded that "failed intubations were significantly fewer when videolaryngoscopy was used in participants with anticipated difficult airway." [4], although a similar review found no evidence of benefit in children [5]. In addition to this, the recent DAS guidelines on intubation in critically ill adults acknowledge the role of videolaryngoscopy [6], stating that "if difficult laryngoscopy is predicted then videolaryngoscopy should be considered from the outset". However, these publications deal largely with the management of intubation in patients who are anaesthetised. This month's issue of Anaesthesia presents a systematic review comparing awake videolaryngoscopy and awake fibreoptic intubation in patients with anticipated airway difficulty [7]. Using standard systematic review methodology, the authors included eight studies overall. One study could not be included in the quantitative meta-analysis,...

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Section: Technical Detailsmentioning

confidence: 99%

The emerging role of awake videolaryngoscopy in airway management

Wilson

Smith

2018

Anaesthesia

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“…The sedative and analgesic effect of a low dose of a single agent is poor, resulting in obvious pain and an inability to cooperate well with the tracheal intubation. However, high doses may cause adverse effects, such as different degrees of inhibition of the respiratory and circulatory systems, that threaten the lives and safety of patients [4,5].…”

Section: Introductionmentioning

confidence: 99%

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

Peng

Sun

et al. 2020

Preprint

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“…All of these studies showed that as with awake fiberoptic intubation, awake VL-assisted intubation achieved a high success rate, satisfactory intubation times, and a high acceptance of patients and anesthesiologists. Thus, it is concluded that in patients with predicted and known difficult intubations, awake VL-assisted intubation represents an acceptable alternative to awake fibreoptic intubation (36)(37)(38)(39)(40).…”

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confidence: 99%

Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

Xue¹,

Liu²,

Li³

et al. 2018

J Anesth Perioper Med

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Aim of review:The aim of this article is to convey several hotspot issues regarding the use of videolaryngoscopy (VL) in airway management that anesthesiologists are often concerned. Methods: Recent literature in the past 20 years about the use of VL in the clinical airway management were searched from the Pubmed and Cochrane databases and reviewed, in order to determine the strengths and weakness of VL and conflicting issues regarding the role of VL in airway management. Recent findings: The benefits of VL are most significant in patients with difficult airways, with an improved laryngeal view and an increased success rate of intubation. However, VL cannot give a 100% success rate and there is no specific evaluation system of difficult or failed VL as with direct laryngoscopy. Awake VL-assisted intubation is a useful alternative to awake fiberoptic intubation, but the fiberoptic bronchoscope cannot be discarded and still is gold standard tool of difficult airway management. There are several differenttype VLs available and their efficacies may be different between devices due to various designs and shapes. Due to the limited number of comparative studies, however, there is inconclusive evidence to recommend which VL design is more advantageous in various clinical situations. A Macintosh-type VL allows residents to learn laryngoscopy and intubation more quickly and effectively. Given that VL has tremendous advantages, it should be used as the first-line device for all tracheal intubations. Summary: The introduction of VL has resulted in a dramatic transformation of clinical airway management and is seen as the evolutionary step in intubation technology. There are considerable disagreements over the role of VL in airway management and the need of more investigation, but VL continues to get popularity both inside and outside the operating room. With increasing use of VL in airway management, experience and skill will undoubtedly increase, and the evidence will suggest that the attempt numbers and complications of intubations may be decreased, and patient safety can be improved. (Funded by the Major Project of Zhejiang Science and Technology Fund.) ABSTRACT

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A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)^®for awake oral tracheal intubation

Abstract: SummaryWe compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope â in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml

Cited by 39 publications

References 29 publications

The emerging role of awake videolaryngoscopy in airway management

The emerging role of awake videolaryngoscopy in airway management

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

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A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)®for awake oral tracheal intubation

Abstract: SummaryWe compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope â in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml

Cited by 39 publications

References 29 publications

The emerging role of awake videolaryngoscopy in airway management

The emerging role of awake videolaryngoscopy in airway management

Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial

Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

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Product

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A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)^®for awake oral tracheal intubation