Fiberoptic intubation and laryngeal morbidity : A randomized controlled trial

• Published in: Anesthesiology (Philadelphia) 2007-10, Vol.107 (4), p.585-590
• Main Authors: HEIDEGGER, Thomas, STARZYK, Lukas, VILLIGER, Cornelia R, SCHUMACHER, Stefan, STUDER, Rolf, PETER, Barbara, NUEBLING, Matthias, GERIG, Hans J, SCHNIDER, Thomas W
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia, Inhalation; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Erythema - pathology; Female; Fiber Optic Technology; Hoarseness - epidemiology; Hoarseness - etiology; Humans; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - instrumentation; Larynx - injuries; Male; Medical sciences; Postoperative Complications - epidemiology; Prospective Studies; Vocal Cords - injuries
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/01.anes.0000281925.61143.b5

Tracheal intubation with neuromuscular blocking agents is associated with a low incidence of minor vocal cord sequelae (8%). The aim of this noninferiority trial was to demonstrate that the frequency of vocal cord sequelae after fiberoptic intubation with a flexible silicone tube without neuromuscular blocking agents was less than 25% (maximum tolerable inferiority). Two-hundred seventy patients were prospectively randomized to two groups. All intubations were performed by anesthesiologists with extensive experience in fiberoptic and conventional techniques. Fiberoptic nasotracheal intubation consisted of a bolus dose of 2 microg/kg fentanyl; 0.25 ml cocaine instillation, 10%, into nasal canals; cricothyroid injection of 2 ml lidocaine, 1%; bronchoscopy; administration of 0.3 mg/kg etomidate; and advancing a flexible silicone tube after loss of consciousness. Orotracheal intubation was performed with a polyvinyl chloride tube after induction with 2 microg/kg fentanyl, 2 mg/kg propofol, and 0.6 mg/kg rocuronium. Patients were examined by laryngoscopy before surgery, 24 h after surgery, and daily until complete restitution. Postoperative hoarseness was assessed by a standardized interview. The incidence of vocal cord sequelae was 11 out of 130 (8.5%) in the fiberoptic group versus 12 out of 129 (9.3%) in the control group (chi-square = 0.057, df = 1, P = 0.81; upper limit of the one-sided 95% confidence interval for the difference: +5.1%). There were no persistent injuries. The incidence of postoperative hoarseness was 4% in both groups. Because fiberoptic intubation without neuromuscular blocking agents is safe regarding vocal cord sequelae, routine use is justified for anesthesiologists experienced in this technique.