COMPARISON OF A RIGID LARYNGOSCOPE WITH THE ULTRATHIN FIBEROPTIC LARYNGOSCOPE FOR TRACHEAL INTUBATION IN INFANTS

The flexible ultrathin fibreoptic laryngoscope allows placement of end otracheal tubes as small as 2.5 mm internal diameter. The purpose of t his study was to document the safety and efficacy of intubation using an ultrathin fibreoptic laryngoscope. Proved safety and efficacy would justify the routine use of fibreoptic laryngoscopy in normal infants to maintain skills needed for management of the difficult infant airwa y. In this prospective study, 40 infants <24 mo of age scheduled for e lective surgery were randomly divided into two equal groups. After inh alation induction of anaesthesia, in 20 infants the trachea was intuba ted using direct rigid laryngoscopy, and in 20 using the ultrathin fib reoptic laryngoscope (size 1.8 mm OD) Olympus LFP. Time to successful intubation was recorded, as well as blood pressure, heart rate, end-ti dal CO2 and oxygen saturation. Airway trauma in the operating room, th e post-anaesthesia care unit, and on the first postoperative day was r ecorded. The intubation times using rigid laryngoscopy were less than those using fibreoptic laryngoscopy (13.6 +/- 0.9 sec (mean +/- SEM) v s 22.8 +/- 1.7 sec; P < 0.01). Oxygen saturation and end-tidal CO2 rea dings were not different between the two groups. After intubation, blo od pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the a irway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscopy is a safe and effective method for tracheal intubation i n infants and may be used routinely in order to maintain fibreoptic ai rway skills.