Acta Medica Iranica 2011. 49(4):201-207.

Bonfils Fiberscope: Intubating Conditions and Hemodynamic Changes without Neuromuscular Blockade
Atabak Najafi, Eiman Rahimi, Reza Shariat Moharari, Zahid Hussain Khan

Abstract


To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs). METHODS: In this randomized controlled trial,80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg-1 was administered, followed by intravenous alfentanil 20 µg.kg-1, lidocaine 1.0 mg.kg-1, and propofol 2 mg.kg-1 sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465). Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P


Keywords


Laryngoscopes; Intubation; Intratracheal; Propofol; Alfentanil; Neuromuscular Blocking Agents

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References


Mertes PM, Laxenaire MC, Alla F; Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology 2003;99(3):536-45.

Mertes PM, Laxenaire MC. Adverse reactions to neuromuscular blocking agents. Curr Allergy Asthma Rep 2004;4(1):7-16.

Harboe T, Guttormsen AB, Irgens A, Dybendal T, Florvaag E. Anaphylaxis during anesthesia in Norway: a 6- year single-center follow-up study. Anesthesiology 2005;102(5):897-903.

Baillard C, Adnet F, Borron SW, Racine SX, Ait Kaci F, Fournier JL, Larmignat P, Cupa M, Samama CM. Tracheal intubation in routine practice with and without muscular relaxation: an observational study. Eur J Anaesthesiol 2005;22(9):672-7.

Erhan E, Ugur G, Alper I, Gunusen I, Ozyar B. Tracheal intubation without muscle relaxants: remifentanil oralfentanil in combination with propofol. Eur J Anaesthesiol 2003;20(1):37-43.

Maktabi MA, Smith RB, Todd MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology 2003;99(2):247-8..

Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal= morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003;98(5):1049-56.

Davidson JA, Gillespie JA. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and i.v. lignocaine. Br J Anaesth 1993;70(2):163-6.

Jabbour-Khoury SI, Dabbous AS, Rizk LB, Abou Jalad NM, Bartelmaos TE, El-Khatib MF, Baraka AS. A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocainepropofol in the absence of muscle relaxants. Can J Anaesth 2003;50(2):116-20.

Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg 1992;75(5):788-93.

Lieutaud T, Billard V, Khalaf H, Debaene B. Muscle relaxation and increasing doses of propofol improve intubating conditions. Can J Anaesth2003;50(2):121-6.

Bein B, Worthmann F, Scholz J, Brinkmann F, Tonner PH, Steinfath M, Dörges V. A comparison of the intubating laryngeal mask airway and the Bonfils intubation fibrescope in patients with predicted difficult airways. Anaesthesia 2004;59(7):668-74.

Bein B, Yan M, Tonner PH, Scholz J, Steinfath M, Dörges V. Tracheal intubation using the Bonfils intubationfibrescope after failed direct laryngoscopy. Anaesthesia 2004;59(12):1207-9.

Halligan M, Charters P. A clinical evaluation of the Bonfils Intubation Fibrescope. Anaesthesia2003;58(11):1087-91.

Wong P. Intubation times for using the Bonfils intubation fibrescope. Br J Anaesth 2003;91(5):757; author reply 757-8.

Vlatten A, Aucoin S, Litz S, MacManus B, Soder C. A comparison of bonfils fiberscope-assisted laryngoscopy and standard direct laryngoscopy in simulated difficult pediatric intubation: a manikin study. Paediatr Anaesth 2010;20(6):559-65.

Xue FS, P Liu H, Xiong J, J Yuan Y, Liao X. Comments on comparison of Bonfils fiberscope-assisted laryngoscopy with standard direct laryngoscopy in simulated difficult pediatric intubation. Paediatr Anaesth 2010;20(8):778-9; author reply 779-80.

Corbanese U, Morossi M. The Bonfils intubation fibrescope: clinical evaluation and consideration of the learning curve. Eur J Anaesthesiol 2009;26(7):622-4.

Powell L, Andrzejowski J, Taylor R, Turnbull D. Comparison of the performance of four laryngoscopes in a high-fidelity simulator using normal and difficult airway. Br J Anaesth 2009;103(5):755-60.

Byhahn C, Nemetz S, Breitkreutz R, Zwissler B, Kaufmann M, Meininger D. Brief report: tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway. Can J Anaesth 2008;55(4):232-7.

Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia 2008;63(7):745-60.

Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg 2003;96(2):595-9, table of contents.

Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985;32(4):429-34.

Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42(5):487-90.

Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a metaanalysis of bedside screening test performance. Anesthesiology 2005;103(2):429-37.

Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol 2004;4:26.

Cooper R, Mirakhur RK, Clarke RS, Boules Z. Comparison of intubating conditions after administration of Org 9246 (rocuronium) and suxamethonium. Br J Anaesth 1992;69(3):269-73.

Reves JG, Glass PSA, Lubarsky DA, McEvoy MD. Intravenous nonopiod anaesthetics. In: Miller RD, editor. Miller's Anaesthesia. 6th ed. New York: Churchill Livingstone; 2005. p. 323.

Andel H, Klune G, Andel D, Felfernig M, Donner A, Schramm W, Zimpfer M. Propofol without muscle relaxants for conventional or fiberoptic nasotracheal intubation: a dose-finding study. Anesth Analg 2000;91(2):458-61.

Halligan M, Charters P. A clinical evaluation of the Bonfils Intubation Fibrescope. Anaesthesia2003;58(11):1087-91.


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