A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation.

We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml(-1) and midazolam. The airway was anaesthetised with lidocaine spray and gargle. The total procedure time - a composite of sedation time, topical anaesthesia time and intubation time - was recorded. The operator's impression of the ease of the procedure and the patients' reported comfort were recorded on a 0-100 mm visual analogue scale. The median (IQR [range]) for total procedure time was 900 (739-1059 [616-1215]) s with the fibrescope and 651 (601-720 [498-900]) s with the Pentax Airway Scope (p = 0.0001). The median (IQR [range]) intubation time was 420 (283-480 [120-608]) s with the fibrescope and 183 (144-220 [107-420]) s with the Pentax Airway Scope (p = 0.0002). The median (IQR [range]) visual analogue scores for the operator's ease of intubation for the fibrescope and Pentax Airway Scope were 83.6 (72.0-98.0 [49.0-100.0]) and 86.8 (84.0-91.0 [61.0-100.0]), respectively (p = 0.3507). The median (IQR [range]) visual analogue score for patient comfort was 85.5 (81.0-97.0 [69.0-100.0]) and 79.4 (74.0-85.0 [59.0-100.0]) for the fibrescope and Pentax Airway Scope, respectively (p = 0.06). Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.

Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach.

We compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. Although the insertion time was similar, the time taken to intubate the trachea was significantly shorter with the LMA-CTrach as compared with the ILMA-FOS, with a mean time (SD) for ILMA-FOS and CTrach 84 (32) and 53 (21) s, respectively (p < 0.001). The mean difference in the total time between the two techniques was 31 s, with a 95% confidence interval of 22 to 39 s. Thirty (71%) anaesthetists preferred LMA-CTrach as compared with ILMA-FOS (p = 0.008). We conclude that LMA-CTrach is a suitable alternative to fibreoptic-guided intubation through ILMA for the management of unanticipated failed intubation.

Comparison of fibreoptic-guided orotracheal intubation through classic and single-use laryngeal mask airways.

We compared times to intubate the trachea orally and success rates using two fibreoptically assisted techniques in 42 healthy patients with normal airways using (a) a 6.0-mm nasal RAE tracheal tube passed through a classic laryngeal mask airway (CLMA group) or (b) a 6.0-mm nasal RAE tracheal tube passed through a new disposable Portex Soft Seal laryngeal mask airway (PLMA group). The mean (SD) total intubation times were 82 (14) and 80 (17) s, respectively (p = 0.55). The success rates for intubation at the first attempt were similar (17/21 in the CLMA vs. 16/21 in the PLMA group; p = 0.50). We conclude that there is no clinically significant difference between the times to intubate the trachea or success rates using these two devices, but there may be other more subtle measures which might influence the choice of device in clinical practice. Finally, in the course of this study we developed a grading scale to describe the laryngeal views obtained when using a fibrescope passed through supraglottic airway devices.

Human immunodeficiency virus and Guillain 'Barre' syndrome in intensive care unit patients.

Among 155 medical admissions to the intensive care unit during the period 1989 to 1990, 16 patients had Guillain-'Barre' Syndrome (GBS), five of whom were HIV positive. Out of the five cases, three had manifested herpes zoster and one had TB. The impact of HIV infection o GBS is discussed.