The intubation of the trachea is a crucial procedure in anaesthesia and emergency
medicine, therefore it is considered as one of the core competences in these disciplines.
Novices in the field need to learn intubation fast and without harming patients to ensure
a patent airway if needed.
According to the European Union of Medical Specialists (U.E.M.S., 1050 Brussels, BE),
every anaesthesiologist has to master different techniques for the airway management. One
is the fiberoptic intubation in awake or asleep patients, to manage a difficult airway.
For further training, these core competences need to be extended during the career, from
level A (has knowledge) to level D (teaches or supervises others). As the intubation with
flexible fiberoptic scopes is the gold standard for the management of a known difficult
airway, the investigators want to compare this to a new technique. The use of flexible
scopes do not guarantee easy intubation in every difficult airway situation and
intubation sometimes is difficult to achieve and requires high proficiency (unability to
steer, unability to overcome an anatomical obstacle). Various approaches were introduced
by the medical device industry to overcome that problem. One new device is a rigid video
stylet with a flexible tip (Karl Storz C-MAC VS), which is an advancement of the older
rigid scope "Bonfils" (Karl Storz).
Intubation training with the Bonfils stylet has been shown to require about 20
consecutive tracheal intubations by novices to reach expert time. Learning curves for
fiberoptic intubations seem to be similar, but a greater variance was observed. A study
of the investigators research-group (unpublished data, KEK 247/09), comparing learning
curves between the rigid fiberoptic Bonfils and the semi-rigid fiberoptic SensaScope
suggested a 90% success rate for intubation within 60 seconds after about 15 trials
(Bonfils) and 20 trials (SensaScope). In comparison, there is no validated data for the
use of rigid scopes with flexible tips, as these tool are very new.
Video stylets are tools originally designed for difficult airway management as well. The
C-MAC VS combines rigid and semi-rigid abilities. Intubation seems to become very easy.
But yet, there is no data available which proves that assumption. Thus the study wants to
evaluate if intubation success and time is superior with the C-MAC Video Scope compared
to the difficult intubation gold standard, the intubation with a standard flexible
fiberoptic scope.
