Combined Video Laryngoscope and Fiberoptic Nasal Intubation

Abstract

Techniques for facilitating nasal intubation and reducing associated airway trauma are well documented in the literature. This case series describes an additional technique that combines the use of the video laryngoscope and fiberoptic bronchoscope for intubation. Rather than first starting with the fiberoptic bronchoscope, an endotracheal tube is passed through the nasopharynx and lined up with the glottis using video laryngoscopy. Subsequently, the fiberoptic bronchoscope is used only to guide the endotracheal tube through the glottis. The two perspectives simultaneously provide enhanced guidance to the operator, which can, in turn, reduce the burden of fiberoptic navigation through blood, secretions, and/or altered airway anatomy. Additionally, our report demonstrates that this procedure can be used as a rescue measure when Magill forceps are unsuccessful.

Airway management in a two‐year‐old child with a tongue tumor using video laryngoscope‐assisted flexible bronchoscopic nasotracheal intubation (hybrid technique)

“…The use of video laryngoscope‐assisted flexible bronchoscopic intubation has been described in several case reports for both nasal and oral intubation method in adult patients. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 All these reports describe the hybrid technique as a safe method with only few side effects. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 There are also some reports of its use in pediatric anesthesia.…”

“… 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 All these reports describe the hybrid technique as a safe method with only few side effects. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 There are also some reports of its use in pediatric anesthesia. Stein and colleagues reviewed observational data from the International Pediatric Difficult Intubation Registry from 2017 to 2021, and compared in a retrospective 4:1‐mixed propensity score observation 140 patients who underwent 180 hybrid attempts with 560 patients who underwent 800 attempts with a flexible bronchoscope.…”

Tongue retraction using a McIvor blade improves airway condition during fiberoptic intubation: a randomized controlled trial

“…However, most of them recommended the use of the fiberoptic scope as a dynamic stylet rather than for a FOI process 22 – 24 . Combinational use needs at least two physicians to perform the process and is usually utilized as a last resort for extremely difficult cases rather than a routinely airway securing method to facilitate FOI 25 .…”

Articulating Video Stylet Compared to Other Techniques for Endotracheal Intubation in Normal Airways: A Simulation Study in Consultants with No Prior Experience

“…In particular, the main challenge with VLSs is to properly direct the endotracheal tube (ETT) through the vocal cords, which has also been called the "laryngoscopy paradox". In order to facilitate the task of properly guiding the ETT, it has been suggested to combine the use of VLS or DL (to open the upper airways) with the fiberoptic bronchoscope (FOB), in the so-called combined laryngo-bronchoscope intubation (CLBI) approach, which has been used in challenging clinical cases [19][20][21][22], even in the pediatric population [23]; moreover, the combined technique has been reported also with the use of FOBs with supraglottic airway devices [24,25]. Some preliminary studies on the CLBI approach have been conducted [26][27][28][29], but the results of these studies are probably significantly influenced by the operator's skills in terms of the manipulation of the FOB.…”