C-MAC + Bonfils Scope for Extremely Difficult Airways

January 23, 2018

Spoon Feed
The combination of videolaryngoscopy (VL) and Bonfils rigid intubation endoscope (BIE) was an excellent way to safely intubate patients with extremely difficult airways.

Why does this matter?
Having a difficult airway plan is important, potentially life saving.  Most start with a VL, have a bougie handy, and will pop in a LMA in a pinch, reserving emergency cricothyrotomy as a final option.  There are a few case reports using a combination of VL with endoscopy, but it has not been rigorously studied.  I tinkered around with a Bonfils rigid intubating scope (link is a video) on a manikin once at ACEP, and it was fantastic.  But it is totally different than any other kind of intubation and not that intuitive, so practice a lot on a manikin or cadaver before using it on a patient.

Lights, cameras, intubate…
This was a non-randomized study of 38 patients with known difficult airway or at least 1 predictor of difficult airway and Cormack & Lehane grade III or IV view on VL with a C-MAC.  In other words, these were very difficult airways.  C&L grade was scored 3 times and a photo taken at each stage: DL, VL, and VL+BIE. Two anesthesiologists blinded to the method used for the photo viewed the glottic images and assessed C&L grade at each stage.  Overall, C&L grade improved with the combined VL+BIE approach in 33/38 (87%). This is a great way to approach patients with known or highly suspected difficult airway – assuming you have a Bonfils endoscope, which isn’t cheap.

Source
Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways.  Anesth Analg. 2017 Dec 15. doi: 10.1213/ANE.0000000000002739. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.