Experience of fiberoptic intubation in patients coming for general surgery in a tertiary care hospital
Background: The fiberoptic bronchoscope is the most advanced device for successful oro-/nasotracheal intubation in patients with most difficult airway. The fiberoptic bronchoscope (FOB) is recently made available in general operation theatre Sir Ganga Ram Hospital (SGRH) Lahore. This study was conducted on patients undergoing general surgery requiring general anaesthesia and endotracheal intubation.
Objectives: The objectives of this study were to study the number of attempts and reasons for failure to achieve successful orotracheal intubation by anesthetists inexperienced in using this device during the learning curve in anesthetized paralyzed patients.
Patients and methods: This study was conducted on 249 patients, aged between 16-80 years coming for routine elective surgeries over a period of five months. Fiberoptic bronchoscope and all relevant equipment was prepared and checked before the start of procedure.
Results: A total of 249 patients were intubated with FOB, out of which 50 were male and 199 were female. Anticholinergics were given to 26 patients and 223 patients did not receive any anticholinergics medication. Suction was used to remove secretions in 25 out of 249 patients. Out of 249 attempts of intubation with FOB, 208 patients were intubated successfully in first attempt (83.93%); 31 were intubated in second attempt (12.44%); only 2 were intubated during third attempt (0.88%, <1%). Sixty-seven (27%) patients were intubated successfully within 30 seconds, another 167 (67.17%) were intubated within 60 seconds. Attempts to intubate with fiberoptic bronchoscope failed in 7 patients (2.81%). Hypoxia, increased secretions, blurred vision and failure to identify the anatomical landmarks were the main reasons for failed intubation.
Conclusion: Fiberoptic intubation can be achieved with reasonable success rates by the anesthetists not well experienced in using this device. Failure to identify anatomical landmarks, presence of increased amounts of secretions, blurred vision and desaturation due to repeated and prolonged attempts remain the commonest causes of failed intubation.