Awake Intubation with the Bonfils Fibrescope in Patients with Difficult Airway

Background: In the majority of patients with difficult airways intubated using the Bonfils fibrescope, intubations have been performed under general anaesthesia. Our aim is to report a consecutive series of intubations on awake patients with anticipated difficult airways, performed using the Bonfils fibrescope.

Methods: A prospective case series of intubations performed with the Bonfils fibrescope by a single anaesthesiologist is described in this article. Thirty patients with anticipated difficult airways were included (11 of them after failed intubations with Macintosh laryngoscope). Awake intubation attempts were performed under mild sedation and topical anaesthesia (with or without transcricothyroid membrane injection). The effectiveness was assessed in terms of success rate, number of attempts, difficulties, and complications encountered.

Results: Overall, awake intubation was successful in 29 out of 30 patients (96.6%). In the predicted difficult airway group, 19 patients with anticipated difficult airways were included. Awake intubation with Bonfils fibrescope was successful in 18 out of 19 patients (94.7%). In the known failed intubation group, 11 patients were included; the airways of five of them had already been managed with flexible fibrescope. All patients were successfully intubated awake with the Bonfils fibrescope.

Conclusions: Our findings confirm that awake intubation with the Bonfils fibrescope is well tolerated and highly successful, even if performed by operators in training, and strengthen the evidence that the Bonfils fibrescope is one of the most promising devices to assist intubation in patients with difficult airways.