Flexible nasal bronchoscopy vs. Airtraq^® videolaryngoscopy for awake tracheal intubation: a randomised controlled non‐inferiority study

Abstract

Videolaryngoscopy is a suitable alternative to flexible bronchoscopy to facilitate awake tracheal intubation. The relative effectiveness of these techniques in clinical practice is unknown. We compared flexible nasal bronchoscopy with Airtraq â videolaryngoscopy in patients with an anticipated difficult airway scheduled for awake tracheal intubation. Patients were allocated randomly to flexible nasal bronchoscopy or videolaryngoscopy. All procedures were performed with upper airway regional anaesthesia blockade and a target-controlled intravenous infusion of remifentanil. The success rate with the allocated technique was the primary outcome. A non-inferiority analysis with a predefined limit of 8% was planned. Seventy-eight patients were recruited, allocated randomly and analysed. The rate of successful intubation was 97% and 82% in the flexible bronchoscopy and videolaryngoscopy groups, respectively, p = 0.032. The median (IQR [range]) time to tracheal intubation was shorter with the Airtraq, 163 (105-332 [40-1004]) vs. 217 (180-364 [120-780]) s, p = 0.030. There were no significant differences for complications found between the groups. The median visual analogue scale for ease of intubation was 8 (7-9 [0-10]) for Airtraq vs. 8 (7-9 [0-10]) for flexible bronchoscopy, p = 0.710. The median visual analogue scale for patient comfort for Airtraq was 8 (6-9 [2-10]) vs. 8 (7-9 [3-10]) for flexible bronchoscopy, p = 0.370. The Airtraq videolaryngoscope is not non-inferior to flexible bronchoscopy for awake tracheal intubation in a clinical setting when awake tracheal intubation is indicted. It may be a suitable alternative when judged on a case-by-case basis.

The Safety and Efficacy of Remimazolam Compared to Dexmedetomidine for Awake Tracheal Intubation by Flexible Bronchoscopy: A Randomized, Double-Blind, Controlled Trial

“…ATI-FB is an ideal intubation technique for dealing with predictably difficult airways. 24 , 25 The patient’s quietness, compliance, and adequate local anesthesia of the airway are critical for the effective completion of this technique. 1 , 26 , 27 The results of this study showed that the differences of epinephrine and norepinephrine at T3 were not statistically significant in the three groups, indicating that the three groups effectively suppressed the stress response of tracheal intubation under local anesthesia combined with appropriate sedatives and analgesics.…”

Videolaryngoscopy versus Fiberoptic Bronchoscopy for Awake Tracheal Intubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Hence, although the average outcome is estimated to be negative, in some studies the true outcome may in fact be positive. An examination of the studentized residuals revealed that one study (Kamga H et al, 2023) had a value larger than ±2.6383 and may be a potential outlier in the context of this model. According to the Cook's distances, none of the studies could be considered to be overly influential.…”

“…According to the Q-test, the true results appeared to be heterogeneous (I 2 = 52.5650%). Examination of the studentized residuals revealed that one study (Kamga H et al, 2023) had a higher value of ±2.7729, suggesting it could be a potential outlier in this model. According to…”

“…Examination of the student residuals indicated that none of the studies had a value greater than ±2.7729, suggesting no outliers in this model. According to Cook's distances, one study (Kamga H et al, 2023) could be considered overly influential. Neither the rank correlation test nor the regression test indicated any funnel plot skewness (p = 0.6122 and p = 0.4346, respectively).…”

“…According to the Q-test, the true results appeared to be heterogeneous (I 2 = 52.5650%). Examination of the studentized residuals revealed that one study (Kamga H et al, 2023)…”