Awake intubation with video laryngoscope and fiberoptic bronchoscope in difficult airway patients

摘要

In a randomized clinical trial, Rosenstock et al. showed no significant difference in time to awake intubation by experienced investigators using the McGrath video laryngoscope (MVL) compared with the fiberoptic bronchoscope (FOB) in difficult airway patients. Accordingly, the authors conclude that awake MVL intubation seems to be a potential alternative to awake fiberoptic intubation. However, an important issue ignored by them is that awake intubation actually includes two parts: airway topical anesthesia and subsequent intubation. Moreover, effective airway topical anesthesia is a prerequisite to successfully perform awake intubation. When adequate airway topical anesthesia is obtained, subsequent intubation is usually easy. To obtain a uniform airway topical anesthesia in the two groups, trans-tracheal injection of lidocaine was used in this study. This method is invasive and carries more potential risk than other topical anesthesia methods do. More importantly, it can be difficult or even impossible to perform if the patient's neck anatomy is troublesome to locate. In this study, a total of seven patients were excluded because transtracheal injection was impossible.