Anesthesia and Intensive Care Department, Hospital of Desio, Desio, Milan, Italy.
Minerva Anestesiol. 2010 Sep;76(9):699-706. Epub 2010 Jun 18.
We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices.
The training procedure was divided into two sessions: a theoretical session on difficult airways, the fiber optic bronchoscope (FOB), remifentanil, topical anesthesia and patient interactions; and a session involving simulations of the FOI technique on dummies. For in vivo FOI, we enrolled patients requiring orotracheal intubation for elective surgery. Electrocardiograms, mean arterial pressure (MAP) values, peripheral O(2) saturation (SpO(2)) values, respiratory rates (RR) and sedation scores (OAA/S) were acquired. Remifentanil infusion was started at 0.05-0.1 microg*kg(-1)*min(-1), and patients' upper airways were anesthetized with lidocaine. Remifentanil was titrated to achieve an OAA/S of 9-12. FOBs were inserted, and topical laryngeal anesthesia was achieved ("spray as you go" technique). The instrument was passed into the trachea, the OT tube was railroaded over the fiberscope, and tracheal intubation was completed. The procedure duration and patients' vital parameters and satisfaction were recorded.
Three experts and four less-experienced anesthesiologists who performed 29 (10, 10 and 9) and 25 (6, 6, 6 and 7) FOIs, respectively, joined the study. To reach the target OAA/S, the remifentanil dosage was progressively increased to an average dose of 0.15+/-0.05 microg*Kg(-1)*min(-1). MAP and SpO(2) values were stable throughout the procedures, HR was slightly increased (from 77+/-16 to 90+/-23 bpm, P=0.02), and RR was decreased (from 16+/-3 to 12+/-4 bpm, P<0.05). No differences were recorded between the experts and less-experienced anesthesiologists. The average duration of FOI was 3.3+/-2.0 min for experts and 4.2+/-2.4 min for novices (P=0.03). Procedures were successful in both groups, with patients in each group being equally satisfied with the procedures.
This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.
我们组织了一项在清醒镇静下进行口腔光纤插管（FOI）的培训计划。通过比较专家和新手的表现来评估该计划的效果。
培训过程分为两个阶段：第一阶段是关于困难气道、纤维支气管镜（FOB）、瑞芬太尼、局部麻醉和患者互动的理论课程；第二阶段是在模拟人体上进行 FOI 技术模拟。对于体内 FOI，我们招募了需要进行择期手术的经口气管插管患者。采集心电图、平均动脉压（MAP）值、外周血氧饱和度（SpO2）值、呼吸频率（RR）和镇静评分（OAA/S）。瑞芬太尼以 0.05-0.1μg*kg(-1)*min(-1)的速度开始输注，并用利多卡因麻醉患者的上呼吸道。滴定瑞芬太尼以达到 OAA/S 9-12。插入 FOB，并采用“边喷边进”技术实现喉内局部麻醉。将器械插入气管，将 OT 管套在纤维镜上，完成气管插管。记录手术过程持续时间和患者的生命体征及满意度。
共有 3 名专家和 4 名经验较少的麻醉师参加了研究，他们分别进行了 29（10、10 和 9）和 25（6、6、6 和 7）次 FOI。为了达到目标 OAA/S，瑞芬太尼的剂量逐渐增加到平均剂量 0.15+/-0.05μg*Kg(-1)*min(-1)。整个过程中 MAP 和 SpO2 值保持稳定，心率略有增加（从 77+/-16 增加到 90+/-23 bpm，P=0.02），呼吸频率降低（从 16+/-3 降低到 12+/-4 bpm，P<0.05）。专家和经验较少的麻醉师之间没有差异。FOI 的平均持续时间为专家 3.3+/-2.0 分钟，新手 4.2+/-2.4 分钟（P=0.03）。两组手术均成功，患者对手术均满意。
本研究强调了结构化 FOI 培训计划的重要性，表明通过在模拟人体上进行练习，有可能学会熟练地进行 FOI。
