Airway management in morbidly obese adolescents: a comparison between Bonfils fiberscope and fiberoptic bronchoscope assisted with direct laryngoscopy

Background and aim
Pediatric patients presenting to bariatric surgery is increasing in percentage in the last years and has become a fast growing epidemic problem. The aim of this study was to evaluate the usefulness of Bonfils fiberscope (BF-L) and fiberoptic bronchoscope (FO-L), assisted by direct laryngoscopy for intubation in morbidly obese adolescents with predicted easy intubation using the El-Ganzouri risk index score.
Patients and methods
Thirty adolescent American Society of Anesthesiologist II–III patients, aged 12–19 years, scheduled for laparoscopic bariatric surgery were randomized into two equal groups for intubation, with assistance of regular Mackintosh laryngoscope in both groups, either group BF-L and group FO-L. The standard protocol for general anesthesia was used for both groups. The primary outcome measure was the visualization quality using the percentage of glottis opening score. The secondary outcome measures were: duration of intubation and number of intubation attempts.
Results
Percentage of glottis opening scores were significantly better in group BF-L, when compared with group FO-L (93±6.44%/83±8%, respectively, =0.002). The intubation success rate was 100% in both groups, and the mean intubation time was significantly longer (16±4.67 s) in group FO-L compared with 11±3.50 s in group BF-L (=0.02). As regards the number of attempts, all patients were successfully intubated on the first attempt in group BF-L, while intubation was successful in 14 patients in group FO-L and one patient on the second attempt, which was statistically insignificant (<0.05).
Conclusion
Orotracheal intubation was performed more rapidly and easily with BF-L and FO-L, with superiority of BF-L than FO-L in patients with predicted easy intubation using the El-Ganzouri risk index score