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A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway.
Anesth Analg. 2013 Nov; 117(5):1217-20.A&A

Abstract

BACKGROUND

The Bonfils Intubation Fibrescope (Bonfils) and the McCoy laryngoscope (McCoy) are airway devices designed to assist tracheal intubation in difficult cases. Individually, both the Bonfils and McCoy have demonstrated superiority to the Macintosh laryngoscope in a simulated difficult airway. In this study, we compared the Bonfils with the McCoy laryngoscope in patients whose tracheal intubation had been intentionally hindered. Our primary hypothesis was that there is a significant difference in the rate of success for tracheal intubation when using the Bonfils or McCoy laryngoscope in patients with an intentionally hindered airway.

METHODS

Patients undergoing elective surgery and requiring general anesthesia and endotracheal intubation were randomized to have intubation performed with either the Bonfils or McCoy laryngoscope. All patients were fitted with a hard cervical collar to simulate a difficult airway. Data collected included the success rate of endotracheal intubation, the time taken for intubation, the number of attempts required, the use of further aids to intubation, hemodynamic variables, and the incidence of adverse events. The primary end point was the relative rate of successful tracheal intubation. Categorical outcome measures were compared using the χ test, or Fisher exact test where appropriate, and the Mann-Whitney U test or unpaired Student t test where data were continuous. For the nonnormally distributed data, log transformation was adopted, and t test was performed if normalcy was achieved.

RESULTS

Sixty adult patients were recruited and randomized into 2 groups of 30 patients each. There was no difference in the rate of successful intubation between groups (95% confidence interval [CI], -11.6% to 11.6%), with a 100% success rate achieved in both groups. We found no statistically significant differences between groups in the time taken for intubation (P = 0.32, 95% CI, 0.90-1.41) and percentage of single attempts (P = 0.47, 95% CI, -30.3% to 9.7%). However, further aids to intubation were required more frequently when using the McCoy laryngoscope (P < 0.001, 95% CI, 0.17-0.46), with 18 patients in the McCoy group requiring the use of an elastic bougie, and no patients in the Bonfils group requiring any aids. There were no significant differences found in the rates of adverse events.

CONCLUSIONS

In the hands of trained operators, there appears to be no clinically significant difference in success, time to intubation, or adverse outcomes, when comparing the Bonfils with the McCoy laryngoscope, in the setting of a simulated difficult airway. The choice to use either device should remain based on appropriate patient selection, available aids, individual operator's experience, and economic circumstances.

Authors+Show Affiliations

From the Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore. Andrew Marriott, MBBS, FANZCA, is currently affiliated with Department of Anaesthesia, Geelong Hospital, Victoria, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24029854

Citation

Abdullah, Hairil Rizal, et al. "A Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients With a Simulated Difficult Airway." Anesthesia and Analgesia, vol. 117, no. 5, 2013, pp. 1217-20.
Abdullah HR, Li-Ming T, Marriott A, et al. A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway. Anesth Analg. 2013;117(5):1217-20.
Abdullah, H. R., Li-Ming, T., Marriott, A., & Wong, T. G. (2013). A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway. Anesthesia and Analgesia, 117(5), 1217-20. https://doi.org/10.1213/ANE.0b013e3182a46fa9
Abdullah HR, et al. A Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients With a Simulated Difficult Airway. Anesth Analg. 2013;117(5):1217-20. PubMed PMID: 24029854.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway. AU - Abdullah,Hairil Rizal, AU - Li-Ming,Teo, AU - Marriott,Andrew, AU - Wong,Theodore Gar-Ling, PY - 2013/9/14/entrez PY - 2013/9/14/pubmed PY - 2013/12/18/medline SP - 1217 EP - 20 JF - Anesthesia and analgesia JO - Anesth Analg VL - 117 IS - 5 N2 - BACKGROUND: The Bonfils Intubation Fibrescope (Bonfils) and the McCoy laryngoscope (McCoy) are airway devices designed to assist tracheal intubation in difficult cases. Individually, both the Bonfils and McCoy have demonstrated superiority to the Macintosh laryngoscope in a simulated difficult airway. In this study, we compared the Bonfils with the McCoy laryngoscope in patients whose tracheal intubation had been intentionally hindered. Our primary hypothesis was that there is a significant difference in the rate of success for tracheal intubation when using the Bonfils or McCoy laryngoscope in patients with an intentionally hindered airway. METHODS: Patients undergoing elective surgery and requiring general anesthesia and endotracheal intubation were randomized to have intubation performed with either the Bonfils or McCoy laryngoscope. All patients were fitted with a hard cervical collar to simulate a difficult airway. Data collected included the success rate of endotracheal intubation, the time taken for intubation, the number of attempts required, the use of further aids to intubation, hemodynamic variables, and the incidence of adverse events. The primary end point was the relative rate of successful tracheal intubation. Categorical outcome measures were compared using the χ test, or Fisher exact test where appropriate, and the Mann-Whitney U test or unpaired Student t test where data were continuous. For the nonnormally distributed data, log transformation was adopted, and t test was performed if normalcy was achieved. RESULTS: Sixty adult patients were recruited and randomized into 2 groups of 30 patients each. There was no difference in the rate of successful intubation between groups (95% confidence interval [CI], -11.6% to 11.6%), with a 100% success rate achieved in both groups. We found no statistically significant differences between groups in the time taken for intubation (P = 0.32, 95% CI, 0.90-1.41) and percentage of single attempts (P = 0.47, 95% CI, -30.3% to 9.7%). However, further aids to intubation were required more frequently when using the McCoy laryngoscope (P < 0.001, 95% CI, 0.17-0.46), with 18 patients in the McCoy group requiring the use of an elastic bougie, and no patients in the Bonfils group requiring any aids. There were no significant differences found in the rates of adverse events. CONCLUSIONS: In the hands of trained operators, there appears to be no clinically significant difference in success, time to intubation, or adverse outcomes, when comparing the Bonfils with the McCoy laryngoscope, in the setting of a simulated difficult airway. The choice to use either device should remain based on appropriate patient selection, available aids, individual operator's experience, and economic circumstances. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/24029854/A_comparison_between_the_Bonfils_Intubation_Fiberscope_and_McCoy_laryngoscope_for_tracheal_intubation_in_patients_with_a_simulated_difficult_airway_ L2 - https://doi.org/10.1213/ANE.0b013e3182a46fa9 DB - PRIME DP - Unbound Medicine ER -