Use of a second fiberoptic bronchoscope to guide oral fiberoptic intubation in 2 patients with existing vocal cord injury.

摘要

Fiberoptic intubation (FOI) has become a standard method in the difficult airway algorithm and can be an important adjunct for oral and maxillofacial surgeons who manage patients with difficult airways due to trauma or neck pathology.x Although the technique is generally safe and effective, it involves the "blind" passage of a tube through the larynx, which has been associated with airway injuries, particularly vocal cord trauma, that can lead to longstanding dyspho-nia.2 In most patients, the risk of injury with significant sequelae is low; however, if the patient has pre-existing laryngeal disease or injury, then the risk of additional laryngeal trauma from a conventional FOI may be unacceptably high. In a study investigating the mechanisms of FOI failure, Johnson et al3 described a technique using a nasally inserted fiberoptic endoscope to observe oral FOI. We describe the clinical use of this technique in the management of 2 patients who presented with a predicted difficult intubation and pre-existing vocal cord pathology. In the first case, 2 orally inserted fiberoptic scopes were used.