Abstract
The flexible ultrathin fibreoptic laryngoscope allows placement of endotracheal tubes as small as 2.5 mm internal diameter. The purpose of this 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 airway. In this prospective study, 40 infants <24 mo of age scheduled for elective surgery were randomly divided into two equal groups. After inhalation induction of anaesthesia, in 20 infants the trachea was intubated using direct rigid laryngoscopy, and in 20 using the ultrathin fibreoptic laryngoscope (size 1.8 mm OD) Olympus LFP. Time to successful intubation was recorded, as well as blood pressure, heart rate, end-tidal CO2 and oxygen saturation. Airway trauma in the operating room, the post-anaesthesia care unit, and on the first postoperative day was recorded. The intubation times using rigid laryngoscopy were less than those using fibreoptic laryngoscopy (13.6 ± 0.9 sec (mean ± SEM) vs 22.8 ± 1.7 sec; P < 0.01). Oxygen saturation and end-tidal CO2 readings were not different between the two groups. After intubation, blood pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the airway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscope is a safe and effective method for tracheal intubation in infants and may be used routinely in order to maintain fibreoptic airway skills.
Résumé
Le fibroscope ultrafin flexible à fibres optiques permet de placer des canules endotrachéales de diamètre interne aussi petit que 2,5 mm. Cette étude vise à démontrer la sécurité et l’efficacité de l’intubation avec un fibroscope ultrafin. La preuve de sa sécurité et de son efficacité justifierait son utilisation courante chez les enfants normaux pour maintenir la dextérité nécessaire à la prise en charge des cas difficiles. Pour cette étude prospective, 40 enfants de 24 mois ou moins programmés pour une chirurgie réglée sont répartis au hasard en deux groupes égaux. Après une induction par inhalation, chez 20 enfants, la trachée est intubée par laryngoscopie rigide directe, et chez un même nombre, avec le fibroscope ultrafin (diamètre externe 1,8 mm) Olympus LFP. Le délai jusqu’à la réussite de l’intubation est enregistré, ainsi que la pression artérielle, la fréquence cardiaque, la CO2 télé-expiratoire et la saturation en oxygène. Tout traumatisme aux voies aériennes en salle d’opération, salle de réveil et au premier jour après l’opération est aussi noté. Le temps requis pour l’intubation avec le laryngoscope rigide est moindre qu’avec le fibroscope (13,6 ± 0.9 sec (moyenne ± SEM) vs 22,8 ± 1,7 sec; P < 0,01). La saturation en oxygène et le CO2 télé-expiratoire ne diffèrent pas entre les deux groupes. Après l’intubation, la pression artérielle et la fréquence cardiaque augmentent également dans les deux groupes et retournent à la normale en deçà d’une ou deux minutes. Pour les tramatismes, il n’y a pas de différence entre les deux groupes. En conclusion, on peut utiliser le fibroscope avec efficacité et sécurité pour l’intubation des enfants et de façon courante pour maintenir son habileté avec ce type d’instrument.
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Research was performed at the Children’s Memorial Hospital, Chicago. Preliminary research results were presented at the American Academy of Pediatrics, Anesthesiology Section, March 1993, Chicago.
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Roth, A.G., Wheeler, M., Stevenson, G.W. et al. Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants. Can J Anaesth 41, 1069–1073 (1994). https://doi.org/10.1007/BF03015656
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DOI: https://doi.org/10.1007/BF03015656