![]() ![]() The present randomized control study was conducted at Al-Zahraa Hospital, AL-Azhar University, from February 2, 2018, to December15, 2018, after receiving institutional approval from the Research Ethics Committee under the registration number N 0 REC-AFHG 2018/2, and written consent was obtained from all participants. The secondary outcome was to compare the incidence and severity of bleeding (an estimation of the quality of the intubation field) after inserting the endotracheal tube. The primary outcome of the present study was to compare oral fiber optic intubation with and without modified bite block as regards to the time of successful intubation (the time from insertion of the fiber optic till the passage of the tube through the vocal cord). All study participants had a difficult airway, which is the most common dangerous and challenging problem for anesthesiologists. Here, we compared two methods of oral FBO intubation under spontaneous ventilation technique: the traditional method (TR group) and a method involving passing the FBO through a longitudinally cut bite block (MB group). However, the safety and efficacy of the use of bite blocks has not been systematically examined in patients with limited neck mobility. However, these devices do not provide a clear passage for oral fiber optic intubation, are more liable for malposition due to their inflexibility (Greenland & Irwin, 2004), and require various maneuvers to facilitate intubation, including patient positioning, jaw thrust maneuvers (Durga et al., 2001a), rotation of the endotracheal tube, and pulling the tongue with Magill forceps (Randell & Hakal, 1997).Ī bite block has been recommended for oral intubation to prevent closure of the tracheal tube and damage to the fiber optic bronchoscope and to maintain a patent airway for suctioning (Stackhouse, 2002 Reed, 2001). The main advantage of these airway devices is that they facilitate oral intubation by the passage of a fiber optic (FBO) along the midline, which is essential for a successful fiber optic intubation (Wheeler & Ovassapian, 2007). Fiber optic intubation is recommended as the safest technique for protecting the airway in difficult intubation situation (Wulf et al., 1997).Ī variety of oropharyngeal intubation devices have been designed including the Ovassapian®, Williams®, and Berman II® airways, and the PatilSyracus® mask. Oral fiber optic intubation with a modified bite block performed under spontaneous ventilation is safer and more effective than traditional fiber optic intubation for patients with limited neck mobility.Īirway management for patients with limited neck mobility can be challenging to the anesthesiologist and may lead to cannot ventilate-cannot intubate scenarios. The quality of intubation field shows a significant difference in p value between MB and TR groups with the best result observed in MB. The time to successful intubation was significantly shorter in the MB group than in the TR group. ![]() Hemoglobin oxygen saturation was significantly greater in the MB group than in the TR group. Resultsīoth groups showed statistically significant increases from baseline in mean arterial pressure and heart rate during the first 3 min after intubation this increase was marked in the TR group than in the MB group. In group MB, the fiber optic was inserted through a modified bite block. In group TR, the traditional technique of oral fiber optic intubation was performed without the use of a bite block. Sixty adult patients with limited neck mobility who were to undergo elective surgery with mandatory tracheal intubation under spontaneous ventilation were assigned to two groups. Here, we performed fiber optic intubation without and with a bite block that was modified to compare the safety and efficacy of the two techniques. Insertion of the fiber optic bronchoscope through a modified bite block might facilitate intubation in such patients. Fiber optic intubation is the safest solution but can be difficult in patients with limited neck mobility. One critical aspect of anesthesia is to provide airway management. ![]()
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