Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal Intubation in Anaesthetised Spontaneously Breathing Paediatric Patients

Abstract

Objective: Flexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route.

Methods: Sixty children aged 6-12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded.

Results: The time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting.

Conclusion: Intubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6-12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.

Keywords: Anaesthesia general; child; fibreoptic bronchoscopy; glottis; intratracheal; intubation.

Figure 1

Consort diagram

Figure 2

Box-and-whisker plots illustrating time to glottic view (in seconds) with FOI and FNI. The inner horizontal line within the box represents the median time for the glottic view, and the outer horizontal lines of the box represent the 25^th and 75^th quartiles. The horizontal lines of the whiskers represent the 95% confidence intervals

Figure 3

Box-and-whisker plots illustrating total intubation time (in minutes) with FOI and FNI. The inner horizontal line within the box represents the median time for the glottic view, and the outer horizontal lines of the box represent the 25^th and 75^th quartiles. The horizontal lines of the whiskers represent the 95% confidence intervals

Figure 4

Haemodynamic parameters (HR and MAP) changes in the two groups