EDITORIAL ARTICLE
Airway management is a critical competence in anesthesiology. The rst goal in any anesthetic procedure is
to maintain airway patency, ensure the ventilation and
patients oxygenation.1 The incidence of failed intubation,
impossible ventilation, and the cannot intubate, cannot
ventilate scenario range up to 7.5%, 0.15% and 0.007%,
respectively.2,3 Apparently these rates are low, however
they affect to thousands or millions of people worldwide.
Thus, the inability to successfully manage a difcult airway (DA) is responsible for 600 deaths annually and 30%
of deaths attributable to anesthesia.4,5 Therefore airway
throughout history has been and should be treated as a
problem to be solved. The introduction of beroptic bronchoscopy (FOB) and video laryngoscopy constitute two major
milestones in the airway management. A considerable technological evolution has happened from the rst design of
exible bronchoscope of Shigeto Ikeda (1966) to the current video endoscopes. FOB is universally recognized as
method for endotracheal intubation. Its popularity is due
to innate features that are not available in any other device
(Table 1).6 These unique properties allow the greatest success of any nonsurgical technique for DA management with
intubation rates of up to 99% and higher.7,8 It is necessary to
meet several conditions to optimize its features9 (Table 2)
and to be aware of their limitations,1 fortunately all salvageable: (1) cost, fragility-maintenance and possibility
of transmission of infectious diseases. Video endoscopes
http://dx.doi.org/10.1016/j.redar.2015.11.008
0034-9356/ 2015 Sociedad Espa
nola de Anestesiologa, Reanimacin y Teraputica del Dolor. Published by Elsevier Espaa, S.L.U. All rights
reserved.
Document downloaded from http://www.elsevier.es, day 29/03/2016. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
190
Table 1
M.. Gmez-Ros
Characteristics of beroptic bronchoscope.
References
1. Frova G, Sorbello M. Algorithms for difcult airway management: a review. Minerva Anestesiol. 2009;75:201---9.
2. Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction
and outcomes of impossible mask ventilation: a review of
50,000 anesthetics. Anesthesiology. 2009;110:891---7.
Document downloaded from http://www.elsevier.es, day 29/03/2016. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.
Can beroptic bronchoscopy be replaced by video laryngoscopy in the management of difcult airway?
3. Heidegger T, Gerig HJ, Ulrich B, Kreienbhl G. Validation of a
simple algorithm for tracheal intubation: daily practice is the
key to success in emergencies --- an analysis of 13,248 intubations. Anesth Analg. 2001;92:517---22.
4. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 2011;25:263---76.
5. Cook TM, Scott S, Mihai R. Litigation related to airway
and respiratory complications of anaesthesia: an analysis of
claims against the NHS in England 1995---2007. Anaesthesia.
2010;65:556---63.
6. Collins SR, Blank RS. Fiberoptic intubation: an overview and
update. Respir Care. 2014;59:865---78, discussion 878---80.
7. Ovassapian A, Yelich SJ, Dykes MH, Brunner EE. Fiberoptic nasotracheal intubation --- incidence and causes of failure. Anesth
Analg. 1983;62:692---5.
8. Ovassapian A, Krejcie TC, Yelich SJ, Dykes MH. Awake breoptic
intubation in the patient at high risk of aspiration. Br J Anaesth.
1989;62:13---6.
9. Koerner IP, Brambrink AM. Fiberoptic techniques. Best Pract Res
Clin Anaesthesiol. 2005;19:611---21.
10. Johnson C, Roberts JT. Clinical competence in the performance
of beroptic laryngoscopy and endotracheal intubation: a study
of resident instruction. J Clin Anesth. 1989;1:344---9.
11. Delaney KA, Hessler R. Emergency exible beroptic nasotracheal intubation: a report of 60 cases. Ann Emerg Med.
1988;17:919---26.
12. Wong DM, Prabhu A, Chakraborty S, Tan G, Massicotte
EM, Cooper R. Cervical spine motion during exible bronchoscopy compared with the Lo-Pro GlideScope. Br J Anaesth.
2009;102:424---30.
13. Abdelmalak BB, Bernstein E, Egan C, Abdallah R, You J, Sessler
DI, et al. GlideScope vs exible breoptic scope for elective
intubation in obese patients. Anaesthesia. 2011;66:550---5.
14. Chan JK, Ng I, Ang JP, Koh SM, Lee K, Mezzavia P, et al. Randomised controlled trial comparing the Ambu aScopeTM 2 with
a conventional breoptic bronchoscope in orotracheal intubation of anaesthetised adult patients. Anaesth Intensive Care.
2015;43:479---84.
15. Kristensen MS. The Parker Flex-Tip tube versus a standard tube
for beroptic orotracheal intubation: a randomized doubleblind study. Anesthesiology. 2003;98:354---8.
16. Michalek P, Hodgkinson P, Donaldson W. Fiberoptic intubation
through an I-gel supraglottic airway in two patients with predicted difcult airway and intellectual disability. Anesth Analg.
2008;106:1501---4 [table of contents].
17. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the
difcult airway: an updated report by the American Society
of Anesthesiologists Task Force on Management of the Difcult
Airway. Anesthesiology. 2013;118:251---70.
18. Artime CA, Hagberg CA. Is there a gold standard for management of the difcult airway. Anesthesiol Clin. 2015;33:233---40.
19. Abernathy JH, Reeves ST. Airway catastrophes. Curr Opin Anaesthesiol. 2010;23:41---6.
20. Cooper RM. Strengths and limitations of airway techniques.
Anesthesiol Clin. 2015;33:241---55.
21. Gil KSL, Diemunsch PA, Hagberg CA. Fiberoptic and exible
endoscopic-aided techniques. In: Benumof and Hagbergs airway management. third ed. Philadelphia: W.B. Saunders; 2013.
p. 365---411.e4 [chapter 19].
22. Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management:
a topical review of the literature. Acta Anaesthesiol Scand.
2010;54:1050---61.
23. Gmez-Ros MA, Serradilla LN. Use of the Airtraq optical
laryngoscope for nasotracheal intubation in predicted difcult airway management in oral surgery. Can J Anaesth.
2010;57:1136---7.
191
24. Gmez-Ros M, Serradilla LN, Alvarez AE. Use of the TruView EVO2 laryngoscope in Treacher Collins syndrome after
unplanned extubation. J Clin Anesth. 2012;24:257---8.
25. De Jong A, Jung B, Jaber S. Intubation in the ICU: we could
improve our practice. Crit Care. 2014;18:209.
26. Weiss M, Engelhardt T. Proposal for the management of
the unexpected difcult pediatric airway. Paediatr Anaesth.
2010;20:454---64.
27. Healy DW, Maties O, Hovord D, Kheterpal S. A systematic review
of the role of videolaryngoscopy in successful orotracheal intubation. BMC Anesthesiol. 2012;12:32.
28. Kramer A, Mller D, Pfrtner R, Mohr C, Groeben H. Fibreoptic vs
videolaryngoscopic (C-MAC() D-BLADE) nasal awake intubation
under local anaesthesia. Anaesthesia. 2015;70:400---6.
29. Abdellatif AA, Ali MA. GlideScope videolaryngoscope versus exible beroptic bronchoscope for awake intubation of morbidly
obese patient with predicted difcult intubation. Middle East J
Anaesthesiol. 2014;22:385---92.
30. Rosenstock CV, Thgersen B, Afshari A, Christensen AL, Eriksen
C, Gtke MR. Awake beroptic or awake video laryngoscopic
tracheal intubation in patients with anticipated difcult airway management: a randomized clinical trial. Anesthesiology.
2012;116:1210---6.
31. Silverton NA, Youngquist ST, Mallin MP, Bledsoe JR, Barton ED,
Schroeder ED, et al. GlideScope versus exible ber optic for
awake upright laryngoscopy. Ann Emerg Med. 2012;59:159---64.
32. Saracoglu KT, Acarel M, Umuroglu T, Gogus FY. The use of Airtraq laryngoscope versus Macintosh laryngoscope and beroptic
bronchoscope by experienced anesthesiologists. Middle East J
Anaesthesiol. 2014;22:503---9.
33. Xue FS, Zhang GH, Li XY, Sun HT, Li P, Sun HY, et al. Comparison of haemodynamic responses to orotracheal intubation with
GlideScope videolaryngoscope and breoptic bronchoscope. Eur
J Anaesthesiol. 2006;23:522---6.
34. Langley A, Mar Fan G. Comparison of the Glidescope , exible
breoptic intubating bronchoscope, iPhone modied bronchoscope, and the Macintosh laryngoscope in normal and difcult
airways: a manikin study. BMC Anesthesiol. 2014;14:10.
35. Jepsen CH, Gtke MR, Thgersen B, Mollerup LT, Ruhnau B,
Rewers M, et al. Tracheal intubation with a exible breoptic
scope or the McGrath videolaryngoscope in simulated difcult
airway scenarios: a randomised controlled manikin study. Eur J
Anaesthesiol. 2014;31:131---6.
36. Gmez-Ros MA, Nieto Serradilla L. Combined use of an Airtraq
optical laryngoscope, Airtraq video camera, Airtraq wireless
monitor, and a breoptic bronchoscope after failed tracheal
intubation. Can J Anaesth. 2011;58:411---2.
37. Law JA, Morris IR, Brousseau PA, de la Ronde S, Milne AD. The
incidence, success rate, and complications of awake tracheal
intubation in 1,554 patients over 12 years: an historical cohort
study. Can J Anaesth. 2015;62:736---44.
38. Benumof JL. Awake intubations are alive and well. Can J
Anaesth. 2015;62:723---6.
39. Crosby ET. Considerations for airway management for cervical
spine surgery in adults. Anesthesiol Clin. 2007;25:511---33, ix.
40. Crosby ET. Airway management in adults after cervical spine
trauma. Anesthesiology. 2006;104:1293---318.
41. Hawkyard SJ, Morrison A, Doyle LA, Croton RS, Wake PN.
Attenuating the hypertensive response to laryngoscopy and
endotracheal intubation using awake breoptic intubation. Acta
Anaesthesiol Scand. 1992;36:1---4.
42. Tsubaki T, Aono K, Nakajima T, Shigematsu A. Blood pressure, heart rate and catecholamine response during beroptic
nasotracheal intubation under general anesthesia. J Anesth.
1992;6:474---9.
43. Ovassapian A, Yelich SJ, Dykes MH, Brunner EE. Blood pressure
and heart rate changes during awake beroptic nasotracheal
intubation. Anesth Analg. 1983;62:951---4.