Comparison of Three Video-Assisted Intubation Methods: Rigid Telescopes, C-Mac, Flexible Fiberoptic Bronchoscopy, for Anticipated Difficult Airways

Abstract

Objective: The aim of this study was to compare the efficiency and reliability of rigid telescopes with the two most used video-assisted intubation techniques. The primary outcome of the study is the first attempt orotracheal intubation success rate and the secondary outcomes include intubation time, mucosal injury, and complications during intubation. Materials and methods: All patients that were predicted to have difficult intubation were prepared according to the video-assisted intubation technique and were randomly divided into three groups: Group 1 (REI group; n = 49) included patients that were intubated using rigid endoscope-assisted orotracheal intubation (REI) (0 degrees, 45 degrees, and 70 degrees), 18-cm rigid telescope, full-HD camera, and Macintosh blade. Group 2 (V-MAC Group; n = 51) included patients that underwent tracheal intubation using a videolaryngoscope Macintosh (V-MAC). Group 3 (FFEI group; n = 53) included patients that underwent flexible fiberoptic tracheal intubation. Groups were compared with regard to intubation success rate, intubation time, number of intubation attempts, and intubation-related complications. Results: The study included a total of 153 patients aged 18-60 years who were predicted to have difficult intubation and underwent intubation with phonomicrosurgery and general anesthesia under elective conditions. Demographic and airway findings of the groups were similar, and no significant difference was found among the groups with regard to the number of intubation attempts (p > 0.05). Intubation was successful at the first attempt in 110 (72%), at the second attempt in 26 (17%), and at the third attempt in 17 (11%) patients. No significant difference was found among the three groups with regard to the number of intubation attempts (p > 0.05). Intubation time was significantly longer in the FFEI group compared to the other two groups (p < 0.05). The prevalence of mucosal injury to vocal cords was significantly lower in the REI group compared to other groups (p < 0.05). Conclusion: Rigid telescopes can be considered in elective surgeries of patients predicted to have difficult airway since they allow for rapid assessment of the airway, minimal mucosal damage, and rapid intubation. (C) 2022 Elsevier Ltd. All rights reserved.