Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management

Rosenstock, C.; Thøgersen, Bente; Afshari, Arash; Christensen, Anne‐Lise; Eriksen, Claus; Gätke, Mona Ring

doi:10.1097/aln.0b013e318254d085

Cited by 221 publications

(184 citation statements)

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“…In a small group of patients, Cohn and Zornow found a significantly shorter intubation time in awake oral intubations using a Bullard laryngoscope [9]. In 2012, Rosenstock et al evaluated the effect of a videolaryngoscopic vs fibreoptic oral intubation under local anaesthesia in 100 patients and found no difference in intubation time and success rate [9].…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have described a significantly better glottic view and a higher success rate in difficult tracheal intubations for the indirect laryngoscopes. Some case reports also describe the successful use of these tools under sedation with preserved spontaneous breathing [8][9][10][11][12][13]. However, the standard -and up to now, probably safest -technique for the management of an anticipated difficult intubation is with a bronchoscope under local anaesthesia and mild sedation [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…A study comparing the indirect laryngoscopic with fibreoptic intubation has been performed for oral intubation and yielded similar results for both techniques [9]. However, oral and maxillofacial surgery for tumour resection and plastic reconstruction after trauma or surgery often requires nasal intubation.…”

Section: Introductionmentioning

confidence: 99%

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Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

et al. 2015

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SummaryNumerous indirect laryngoscopes have been introduced into clinical practice and their use for tracheal intubation under local anaesthesia has been described. However, a study comparing indirect laryngoscopic vs fibreoptic intubation under local anaesthesia and sedation appears lacking. Therefore, we evaluated both techniques in 100 patients with an anticipated difficult nasal intubation time for intubation the primary outcome. We also assessed success rate, glottic view, Ramsey score, and patients' and anaesthetists' satisfaction. The median (IQR [range]) time for intubation was significantly shorter with the videolaryngoscope with 38 (24-65 [11-420]) s vs 94 (48-323 [19-1020]) s (p < 0.0001). There was no difference in the success rate of intubation (96% for both techniques; p > 0.9999) and satisfaction of the anaesthetists and patients. We conclude that in anticipated difficult nasal intubation a videolaryngoscope represents an acceptable alternative to fibreoptic intubation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

et al. 2015

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“…Although the flexible bronchoscope has traditionally been the most frequently used device to facilitate awake intubation, rigid video laryngoscopy (VL) has recently been described to facilitate awake intubation with comparable success. [4][5][6] The well-performed awake intubation is a complex interaction of appropriate case selection, good patient preparation, and technical expertise in performing the procedure. It is a skill that should be acquired and maintained by all anesthesiologists.…”

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confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study Incidence, taux de réussite et complications de l'intubation trachéale chez 1554 patients éveillés sur une période de 12 ans: une étude de cohorte historique AbstractPurpose Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) at our institution. Methods The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling. Results Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4 -4 incidenceÁyear -1 ; 95% confidence interval [CI]: -3.0 -4 to 3.0 -5 ; P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidenceÁyear -1 ; 95% CI: 0.076 to 0.083; P \ 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011)(2012)(2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. Conclusions At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway. RésuméObjectif L'intubation trachéale du patient éveillé, qu'on appelle aussi intubation vigile, est une alternative recommandée dans certaines situations précises pour

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“…Additional techniques described after sufficient local anesthesia or topical anesthesia of the airway are tracheotomy [65], establishment of a translaryngeal and/or transtracheal access, use of video laryngoscopy [66,67] and placement of an EGA [68,69] in awake, spontaneously breathing patients.…”

Section: Recommendationmentioning

confidence: 99%

S1 guidelines on airway management

Cavus²,

et al. 2015

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Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management

Abstract: The authors found no difference in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airway.

Cited by 221 publications

References 18 publications

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

S1 guidelines on airway management

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Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management

Abstract: The authors found no difference in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airway.

Cited by 221 publications

References 18 publications

Fibreoptic vs videolaryngoscopic (C-MAC®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC®D-BLADE) nasal awake intubation under local anaesthesia

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

S1 guidelines on airway management

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Product

Resources

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Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia

Fibreoptic vs videolaryngoscopic (C-MAC^®D-BLADE) nasal awake intubation under local anaesthesia