USING A FIBEROPTIC BRONCHOSCOPE FOR DIFFICULT INTUBATION IN ANESTHESIA FOR MAXILLOFACIAL SURGERY

This retrospective study analyzed the cases of difficult intubations c arried out with a fiberoptic bronchoscope between March 1984 and May 1 989. During this period, 222 such procedures were attempted in 131 mal e and 68 female patients. All cases were diagnosed at the preoperative visit. A fiberoptic bronchoscope was used as a guide under topical na sal and laryngeal anaesthesia, together with appropriate benzodiazanal gesia, in order to maintain spontaneous breathing. The nasotracheal ro ute was used in 218 cases. Successful intubation was achieved in 219 c ases (98.6 %), 209 of them (95.4 %) within fifteen minutes. Of the thr ee failures, only one was unpredictable (inability to withdraw the fib eroptic bronchoscope from the endotracheal tube). In the two others, t he technique was subsequently found to have been wrongly indicated : m ajor nasopharyngeal secretions occluded the fiberoptic device in the f irst one, and an anatomically compromised airway led to apnoea under s edation in the other. A narrow nasotracheal passage, spreading oedema, bloody secretions or coughing gave rise to technical difficulties in 39 cases (17.5 %). There was one case of regurgitation without any dra wback. Benzodiazanalgesia was responsible for two cases of respiratory depression. This technique was otherwise very satisfactory, patients being cooperative and frequently having amnesia of intubation. The ind ications for the use of a fiberoptic bronchoscope were : insufficient oral opening, orofacial obstacles to laryngoscopy, and cases where lar yngoscopy had to be avoided. The main drawbacks of this technique were the cost and fragility of fiberoptic device as well as operator effic iency. The anaesthesiologists involved in the present series performed ten easy intubations each with the fiberoptic bronchoscope, and routi nely used the teaching eye-piece. One tracheostomy only was required i n the whole series, because of intubation difficulties. Fiberoptic bro nchoscopy provided safety and only few complications in the management of the difficult airway in maxillofacial surgery.