Teaching the use of fiberoptic intubation in anesthetized, spontaneously breathing patients

In patients with difficult airways, the standard of care involves fiberopti c intubation under spontaneous ventilation. However, the safety and feasibi lity of a fiberoptic intubation teaching program has only been documented i n paralyzed and apneic patients, whereas data obtained in patients under sp ontaneous respiration are limited and conflicting. We evaluated 100 anesthe tized patients undergoing orotracheal fiberoptic intubation. Five anesthesi a residents with no prior experience in fiberoptic laryngoscopy participate d in the study. Ln a randomized fashion, each participant tracheally intuba ted 10 spontaneously breathing patients (Group A: sevoflurane anesthesia vi a an airway endoscopy mask) and 10 paralyzed patients (Group B: total IV an esthesia with propofol, fentanyl, atracurium). Overall rate of success (96% ), defined as successful intubation of the trachea within two attempts, was not different between groups. During fiberoptic intubation, Spo(2) values remained >95% in Group A, whereas Spo(2) decreased to <95% in two patients in Group B. Failure to pass the tube into the trachea over the bronchoscope was encountered in four patients in Group A and in no patient in Group B. Our data suggest that it is safe to teach the use of fiberoptic intubation in anesthetized, spontaneously breathing patients with normal airway anatom y. Implications: Fiberoptic intubation under spontaneous respiration is a w ell established technique for management of difficult airways. Our study de monstrates the feasibility and safety of a novice training program for fibe roptic intubation under general anesthesia, not only in paralyzed patients but also in those breathing spontaneously.