Patient Safety

Páginas: 10 (2451 palabras) Publicado: 22 de enero de 2013
Patient Safety
Section Editor: Soren J. Brull

Case Report

Awake Insertion of the Bonfils Retromolar Intubation
Fiberscope™ in Five Patients with Anticipated
Difficult Airways
Steven I. Abramson, MD*
Allen A. Holmes, MD†
Carin A. Hagberg, MD†

Traditionally, an awake intubation is performed by flexible fiberoptic laryngoscopy. However, many new devices have been developed to assistanesthesiologists
with both routine and difficult airway management, one of which is the Bonfils
Retromolar Intubation Fiberscope™. This device may be more beneficial than the
flexible fiberoptic laryngoscope since it can readily navigate through soft tissue and
physically lift airway structures, is more affordable, durable, and easier to clean.
This case series demonstrates successful use ofthe Bonfils Scope in five patients for
awake orotracheal intubation with anticipated difficult airways.
(Anesth Analg 2008;106:1215–7)

A

ccording to the American Society of Anesthesiologists’ Practice Guidelines for Management of a Difficult Airway, an awake intubation is considered the
primary method to secure a suspected difficult airway.1 Traditionally, an awake intubation is performedby flexible fiberoptic laryngoscopy. However, within
the last decade, many new devices have been developed to assist anesthesiologists in managing patients
with difficult airways. Among these devices are rigid
fiberoptic stylets, one of which is the Bonfils Retromolar Intubation Fiberscope™ (Bonfils; Karl Storz Endoscopy, Tuttlingen, Germany).2,3
The Bonfils (Fig. 1) is a 40 cm long,semi-rigid
optical stylet with an external diameter of 5.0 mm and
a fixed anterior tip curvature of 40 degrees. Its fiberoptic bundle is encased in a stainless steel tube that
provides 15,000 pixel resolution and is manufactured
with (outside of United States) and without a 1.2 mm
working channel. The adult stylet can accommodate
6.5 mm endotracheal tubes or larger3 and the pediatric
From the*Memorial Hermann, Memorial City Hospital, Houston, Texas; and †Department of Anesthesiology, The University of
Texas Medical School at Houston, Houston, Texas.
Accepted for publication December 17, 2007.
Financial support provided by The University of Texas Medical
School at Houston, Houston, Texas.
Work attributed to the Department of Anesthesiology at the
University of Texas Medical School atHouston, Houston, Texas.
Address correspondence and reprint requests to Carin A.
Hagberg, MD, Department of Anesthesiology, The University of
Texas Medical School at Houston, 6431 Fannin, MSB 5.020, Houston,
TX 77030. Address e-mail to carin.a.hagberg@uth.tmc.edu.
Copyright © 2008 International Anesthesia Research Society
DOI: 10.1213/ane.0b013e318167cc7c

Vol. 106, No. 4, April 2008stylet, the Brambrink Intubation Endoscope™ (Brambrink; Karl Storz Endoscopy, Tuttlingen, Germany),
can accommodate 2.5– 6.0 mm endotracheal tubes.
There are two versions of each stylet. One version has
an adjustable eyepiece, allowing for direct visualization during intubation. The other version has a “Direct
Coupled Interface” that displays the image directly on
a video monitor. The eyepiececan also be converted to
project the image onto a remote monitor to provide
better visualization and enhance teaching. There is an
adaptor “slide cone” for fixation of the endotracheal
tube. This adaptor has a side port that allows oxygen
insufflation or instillation of local anesthetic.2,3
The Bonfils fiberscope was developed more than 20
years ago for use by ear-nose-throat surgeons.4Anesthesiologists became interested in the device in the
mid-1990s for management of patients with difficult
airways.5 It has been successfully used to intubate
patients with normal airways, as well as patients with
difficult airways (expected or unexpected), including
those who failed direct laryngoscopic intubation.6 – 8 It
is also useful in patients with limited neck mobility,
patients...
Leer documento completo

Regístrate para leer el documento completo.

Estos documentos también te pueden resultar útiles

  • Perioperative Considerations For Patient Safety During
  • Safety
  • safety
  • Safety
  • safety
  • Safety
  • comer en patientas
  • Pool Safety

Conviértase en miembro formal de Buenas Tareas

INSCRÍBETE - ES GRATIS