Teaching fibreoptic intubation in anaesthetised patients

Abstract

SummaryOne hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptive or rigid intubations. The study was designed to detect a difference of 10% in means (assuming β= 0.05 and 0.2). The incidence of postoperative sore throat, dysphagia or hoarsensess was similar in both groups. We conclude that routine fibreoptic orotracheal intubation in ASA grades 1 and 2 surgical patients is justifiable for teaching this valuable technique. since it increases clinical exposure to fibreoptic intubation, which should be learned and mastered by all anaesthetic residents by completion of their residency.