EVALUATION OF THE EFFICACY OF BONFILS FIBERSCOPE IN MIDLINE APPROACH MANAGEMENT OF DIFFICULT AIRWAY

Background: One of the alternative methods in managing patients with difficult airway is the Bonfils fiberscope.We studied the efficacy of Bonfils fiberscope in comparison to the classical laryngoscope with Macintosh blade in managing patients with grades 3.4 difficult airway. Methods: In this controlled randomized study, 120 patients with grade 3.4 difficult intubation by Cormack and lehane classification, scheduled for elective surgery for cancer under general anesthesia were randomly allocated in two groups, group(M) Macintosh and group (B) Bonfils group. Both groups were compared according to hemodynamic changes( mean arterial blood pressure, pulse rate) after intubation, time of intubation in seconds, number of intubation attempts, need for external laryngeal pressure , number of intubation failure, postoperative anesthetic complications ( sore throat and hoarseness of voice,hypoxia,air way obstruction ). Plasma level of cortisol was compared before and after intubation. Results: Mean time required for successful intubation was significantly less in group (B) (14.4+2.1 seconds) compared to group (M) 60.2+5.9 seconds) .Number of patients needing external laryngeal pressure was significantly less in group (B) 6(10%) compared to group (M) 17(28.3%). Number of intubation failure was significantly less in group (B) 3(5%) compared to group (M) 8(13.3%). The number of patients successfully intubated at first attempt was statistically significantly higher in, group B than group M. The number of patients who needed three and four attempts to be intubated was significantly higher in group M. There was a statistically significant increase in heart rate, and mean arterial blood pressure in group (M) compared to group (B) and compared to pre intubation levels A statistically significant increase in plasma cortisol level was recorded after intubation in group (M) (29.32+4.81) compared to group (B) (21.84+5.01).The incidence of sore throat,hoarsenss of voice,hypoxia and airway obstruction were significantly higher in group M than in group B. Conclusion: Bonfils fiberscope is a valuable aid in difficult intubations, by trained anesthetists and avoids the need for multiple trials with Macintosh blade that may cause many complications.