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A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study.
Paediatr Anaesth. 2010 Jun; 20(6):559-65.PA

Abstract

INTRODUCTION

Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway.

METHODS

Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate.

RESULTS

A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult.

DISCUSSION

The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed.

Authors+Show Affiliations

Department of Pediatric Anesthesia, IWK Health Centre, Halifax, NS, Canada. arnim.vlatten@iwk.nshealth.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20412457

Citation

Vlatten, Arnim, et al. "A Comparison of Bonfils Fiberscope-assisted Laryngoscopy and Standard Direct Laryngoscopy in Simulated Difficult Pediatric Intubation: a Manikin Study." Paediatric Anaesthesia, vol. 20, no. 6, 2010, pp. 559-65.
Vlatten A, Aucoin S, Litz S, et al. A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study. Paediatr Anaesth. 2010;20(6):559-65.
Vlatten, A., Aucoin, S., Litz, S., MacManus, B., & Soder, C. (2010). A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study. Paediatric Anaesthesia, 20(6), 559-65. https://doi.org/10.1111/j.1460-9592.2010.03298.x
Vlatten A, et al. A Comparison of Bonfils Fiberscope-assisted Laryngoscopy and Standard Direct Laryngoscopy in Simulated Difficult Pediatric Intubation: a Manikin Study. Paediatr Anaesth. 2010;20(6):559-65. PubMed PMID: 20412457.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study. AU - Vlatten,Arnim, AU - Aucoin,Sylvie, AU - Litz,Sharon, AU - MacManus,Brian, AU - Soder,Chris, Y1 - 2010/04/12/ PY - 2010/4/24/entrez PY - 2010/4/24/pubmed PY - 2010/10/13/medline SP - 559 EP - 65 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 20 IS - 6 N2 - INTRODUCTION: Difficult airway management in children is challenging. One alternative device to the gold standard of direct laryngoscopy is the STORZ Bonfils fiberscope (Karl Storz Endoscopy, Tuttlingen, Germany), a rigid fiberoptic stylette-like scope with a curved tip. Although results in adults have been encouraging, reports regarding its use in children have been conflicting. We compared the effectiveness of a standard laryngoscope to the Bonfils fiberscope in a simulated difficult infant airway. METHODS: Ten pediatric anesthesiologists were recruited for this study and asked to perform three sets of tasks. For the first task, each participant intubated an unaltered manikin (SimBaby (TM), Laerdal, Puchheim, Germany) five times using a styletted 3.5 endotracheal tube (ETT) and a Miller 1 blade (group DL-Normal). For the second task, a difficult airway configuration simulating a Cormack-Lehane grade 3B view was created by fixing a Miller-1 blade into position in the manikin using a laboratory stand. Each participant then intubated the manikin five times with a styletted 3.5 ETT using conventional technique but without touching the laryngoscope (group DL-Difficult). In the third task, the manikin was kept in the same difficult airway configuration, and each participant intubated the manikin five times using a 3.5-mm ETT mounted on the Bonfils fiberscope as an adjunct to direct laryngoscopy with the Miller-1 blade (group BF-Difficult). Primary outcomes were time to intubate and success rate. RESULTS: A total of 150 intubations were performed. Correct ETT placement was achieved in 100% of attempts in group DL-Normal, 90% of attempts in group DL-Difficult and 98% of attempts in BF-Difficult. Time to intubate averaged 14 s (interquartile range 12-16) in group DL-Normal; 12 s (10-15) in group DL-Difficult; and 11 s (10-18) in group BF-Difficult. The percentage of glottic opening seen (POGO score) was 70% (70-80) in group DL-Normal; 0% (0-0) in group DL-Difficult; and 100% (100-100) in group BF-Difficult. DISCUSSION: The Bonfils fiberscope-assisted laryngoscopy was easier to use and provided a better view of the larynx than simple direct laryngoscopy in the simulated difficult pediatric airway, but intubation success rate and time to intubate were not improved. Further studies of the Bonfils fibrescope as a pediatric airway adjunct are needed. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/20412457/A_comparison_of_bonfils_fiberscope_assisted_laryngoscopy_and_standard_direct_laryngoscopy_in_simulated_difficult_pediatric_intubation:_a_manikin_study_ L2 - https://doi.org/10.1111/j.1460-9592.2010.03298.x DB - PRIME DP - Unbound Medicine ER -