Improving rigid fiberoptic intubation

A comparison of the Bonfils Intubating Fiberscope™ with a novel modification

Ben H. Boedeker, Mary A. Barak-Bernhagen, David J. Miller, Thomas A Nicholas, Andrew Linnaus, W. B. Murray

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.Methods: Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.Results: Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).Conclusions: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.

Original languageEnglish (US)
Article number11
JournalBMC Emergency Medicine
Volume10
DOIs
StatePublished - May 27 2010

Fingerprint

Intubation
Anesthesia
Manikins
Pressure
Equipment and Supplies
Hypopharynx
Telemedicine
Midazolam
Practice Guidelines

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Improving rigid fiberoptic intubation : A comparison of the Bonfils Intubating Fiberscope™ with a novel modification. / Boedeker, Ben H.; Barak-Bernhagen, Mary A.; Miller, David J.; Nicholas, Thomas A; Linnaus, Andrew; Murray, W. B.

In: BMC Emergency Medicine, Vol. 10, 11, 27.05.2010.

Research output: Contribution to journalArticle

Boedeker, Ben H. ; Barak-Bernhagen, Mary A. ; Miller, David J. ; Nicholas, Thomas A ; Linnaus, Andrew ; Murray, W. B. / Improving rigid fiberoptic intubation : A comparison of the Bonfils Intubating Fiberscope™ with a novel modification. In: BMC Emergency Medicine. 2010 ; Vol. 10.
@article{78b093d454594ddfab485d80e061e455,
title = "Improving rigid fiberoptic intubation: A comparison of the Bonfils Intubating Fiberscope™ with a novel modification",
abstract = "Background: The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.Methods: Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.Results: Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68{\%} (15/22) of participants were successful in intubation compared to a 100{\%} success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95{\%}) indicated a preference for the novel fiberscope (n = 20).Conclusions: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.",
author = "Boedeker, {Ben H.} and Barak-Bernhagen, {Mary A.} and Miller, {David J.} and Nicholas, {Thomas A} and Andrew Linnaus and Murray, {W. B.}",
year = "2010",
month = "5",
day = "27",
doi = "10.1186/1471-227X-10-11",
language = "English (US)",
volume = "10",
journal = "BMC Emergency Medicine",
issn = "1471-227X",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Improving rigid fiberoptic intubation

T2 - A comparison of the Bonfils Intubating Fiberscope™ with a novel modification

AU - Boedeker, Ben H.

AU - Barak-Bernhagen, Mary A.

AU - Miller, David J.

AU - Nicholas, Thomas A

AU - Linnaus, Andrew

AU - Murray, W. B.

PY - 2010/5/27

Y1 - 2010/5/27

N2 - Background: The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.Methods: Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.Results: Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).Conclusions: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.

AB - Background: The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.Methods: Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.Results: Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).Conclusions: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.

UR - http://www.scopus.com/inward/record.url?scp=77952712950&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952712950&partnerID=8YFLogxK

U2 - 10.1186/1471-227X-10-11

DO - 10.1186/1471-227X-10-11

M3 - Article

VL - 10

JO - BMC Emergency Medicine

JF - BMC Emergency Medicine

SN - 1471-227X

M1 - 11

ER -