FIBEROPTIC INTUBATION USING ANESTHETIZED, PARALYZED, APNEIC PATIENTS - RESULTS OF A RESIDENT TRAINING-PROGRAM

Background: There is no consensus about the best way to teach fiberopt ic intubation. This study assesses the effectiveness of a training pro gram in which novice anesthetic residents routinely were taught fibero ptic tracheal intubation of anesthetized, paralyzed, apneic patients. Methods: Eight inexperienced anesthetic residents learned fiberoptic a nd conventional tracheal intubation simultaneously during their first 4 months of training, All intubations were performed using general ane sthesia and muscle paralysis, Of these intubations, 223 (23%) were fib eroptic and 743 (77%) were laryngoscopic, Subsequently, their intubati on skills with the two techniques were studied in a prospective, singl e-blind randomized trial involving 131 elective patients, Intubation t imes, Sp(O2), ET(CO2), hemodynamic changes on intubation, and complica tions were recorded for 71 fiberoptic and 57 laryngoscopic intubations . Results: There were two failures of the rigid and one failure of the fiberoptic technique due to inability to intubate within 180 s. In ca ses of failure, the tracheas were intubated successfully after mask ve ntilation by the alternative technique, No hypoxemia or hypercarbia oc curred in any patient. There were no differences in hemodynamic indexe s nor incidence of sore throat or hoarseness between the two groups, M ean intubation times were 56 +/- 24 s (mean +/- SD) for fiberoptic and 34 +/- 10 s (mean +/- SD) for laryngoscopic (P < 0.001). Conclusions: Novices taught fiberoptic intubation and rigid laryngoscopic intubati on under similar conditions, with similar volumes of experience, learn both techniques well, The safety and effectiveness of this training r egimen commend it for inclusion in any residency program.