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

Abstract

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.

A Randomized Prospective Study Comparing C-Mac D-Blade, Airtraq, and Fiberoptic Bronchoscope for Intubating Patients with Anticipated Difficult Airway

“…Kramer A et al [13] compared Fiberoptic versus C-MAC D-BLADE for awake nasal intubation and concluded that the time to tracheal intubation was significantly shorter with C-MAC D-BLADE (38 s for D-BLADE vs. 94 s for Fiberoptic) and the 2 instruments showed insignificant variance regarding success rate. They showed that C-MAC D-BLADE was superior to Fiberoptic and this was similar to our results but the details were different as they used awake nasal intubation but we used oral intubation under general anaesthesia.…”

Awake nasal intubation and topical anaesthesia: how and how much?

“…In their comparative study of fibreoptic and videolaryngoscope-guided awake nasotracheal intubation, Kramer and colleagues report an equal failure rate (4%) in each group, but for different reasons [1].…”

Awake nasal intubation: from darkness into light, or a leap into the unknown?

“…about their study comparing videolaryngoscopy and bronchoscopyassisted nasal intubation in patients with predicted difficult airways [1]. Firstly, we think that there is a clear difference in the management of patients with anatomically 'difficult' airways compared with those with potentially obstructed airways, but it is not clear from the authors' results who had the former and who the latter.…”