How Many Attempts are Needed for Learning Fiberoptic Orotracheal Intubation? / 대한마취과학회지

BACKGROUND: The value of the fiberoptic laryngoscope in difficult tracheal intubation is well established. In recent years there has been a significant interest in and increase in learning this valuable skill by anesthesiologists. This study assesses the minimum number of attempts needed for proficiency in fiberoptic orotracheal intubation. METHODS: Eight anesthesia residents with experience in rigid larygoscopic intubation, but who were beginners in fiberoptic intubation, participated in this study. In a randomized fashion, each resident performed 50 fiberoptic orotracheal intubations. All intubations were performed under general anesthesia and muscle paralysis. Success rate and intubation time of fiberoptic orotracheal intubation and SpO2 were recorded. We have compared success rate with intubation time of fiberoptic orotracheal intubation and grade of laryngoscopic view. RESULTS: The mean success rate of fiberoptic orotracheal intubation was 75% in the first 10 intubations. Thereafter the success rates were higher than 90%. The mean time to achieve successful orotracheal fiberoptic intubation were significantly decreased to 30 attempts. There was no correlation of laryngoscopic grade with intubation time and success rate. No hypoxia occurred in any patient. CONCLUSIONS: We concluded that an acceptable level of technical expertise in fiberoptic orotracheal intubation is achieved after 30 intubation attempts.

The Clinical Assessment of the Efficacy and Safety of the Intubating Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The intubating laryngeal mask airway (ILMA) was introduced recently as an effective ventilatory device and intubation guide. The following study was designed to assess not only efficacy but also safety of the ILMA. METHODS: Sixty adult patients who were randomly assigned in 3 groups (Group 1, 2, 3), ASA class 1 or 2, undergoing elective surgery were induced with intravenous injection of fentanyl, thiopental sodium, vecuronium, lidocaine and inhalation of O2, N2O, enflurane. In Group 1 (n=20), the patients were intubated with Macintosh curved blade and endotracheal tube. In Group 2 (n=20), blind tracheal intubation using an ILMA was attempted. In Group 3 (n=20), we applicated the ILMA to a fiberoptic bronchoscope-aided tracheal intubation. Then we decided success rates for blind and fiberoptic-guided passage of an endotracheal tube via the ILMA. We measured systolic, diastolic arterial pressure and heart rate before administration of induction agent, 1 and 5 minutes after induction, just after intubation, 1, 2, 3 and 5 minutes after endotracheal intubation. RESULTS: The success rates for blind (Group 2) and fiberoptic-guided (Group 3) passage of an endotracheal tube via the ILMA were 70% and 100% respectively. There were no statistically significance in the systolic, diastolic arterial pressure and heart rate when compared to value of any other groups at any time but higher in all groups when compared to preinduction value of each group just after intubation. CONCLUSIONS: Though the ILMA may be an effective intubation guide, it doesn't blunt hemodynamic changes effectively than standard laryngoscopic intubation.

Nasotracheal Intubation Using Fiberoptic Bronchoscope and Guidewire in a Pediatric Mandibular Fracture Patient: A case report / 대한마취과학회지

Although the endotracheal intubation using laryngoscope can usually be performed under general anesthesia, it may be very difficult in situations such as head and neck trauma, hemorrage, or deformity. Recently we performed antegrade fiberoptic nasotracheal intubation with a guide wire. A 15-month aged female child with mandibular fracture was scheduled for open reduction and internal fixation under general anesthesia. She was anticipated difficult intubation due to displacement of the fracture site. After induction of anesthesia, we passed an adult fiberoptic bronchoscope (O.D. 3.8 mm, LF-2, Olympus optical co, Japan) to vocal cord via right nostril. Then a guidewire was inserted through the suction port of bronchoscope, and bronchoscope was removed in a state of guidewire in situ. We slid the endotracheal tube over guidewire according to Seldinger's technique. We think that nasotracheal intubation using an adult fiberoptic bronchoscope and a guidewire is good for children under 2 years old who are expected the difficult intubation.

Sedation and Hemodynamic Stability during Fiberoptic Awake Nasotracheal Intubation: Comparison between Propofol Infusion and Intravenous Boluses of Fentanyl and Midazolam / 대한마취과학회지

BACKGROUND: Crucial to the success of fiberoptic awake tracheal intubation is proper preparation of the patient; this technique will work well in most patients when they are quiet and cooperative and have a larynx nonreactive to physical stimuli. We have attempted to ascertain how well these conditions are achieved with a low-dose infusion of propofol, because of its pharmacological profile. METHODS: Thirty patients, physical status by American Society of Anesthesiologists (A. S. A.) I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive either propofol infusion 1 mg kg-1 h-1 preceded by a 1 mg kg-1 bolus (Group P) or intravenous fentanyl 1ug kg-1 and midazolam 0.05 mg kg-1 (Group F). These two groups were compared in terms of hemodynamic profile, sedation score, condition for intubation, coughing and swallowing. RESULTS: There were no statistically significant differences in mean arterial blood pressures according to time between two groups. But in Group F, heart rates were significantly increased in immediately after transtracheal injection of lidocaine, immediately before the fiberoscopy was started, 1, 2 minutes after start of fiberoscopy, compared to Group P (p<0.05). The patients in Group P were more sedated than those in Group F (p<0.05) but there were no significant differences in condition for intubation, reflex of coughing and swallowing, duration of fiberoptic intubation. CONCLUSIONS: We conclude that propofol is useful sedative agent in fiberoptic awake intubation with similar efficacy to midazolam and fentanyl but with more profound sedation and stable hemodynamic profile. These represent significant advantages for severe anxious or hypertensive patients and prolonged procedure of intubation.