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A comparative evaluation of fibreoptic bronchoscopy versus C-MAC® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients

Évaluation comparative de la bronchoscopie par fibre optique par rapport à la vidéolaryngoscopie guidée par lame D-BLADE C-MAC® pour l’intubation nasotrachéale sous anesthésie générale chez les patient·es opéré·es pour carcinome oropharyngé

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas.

Methods

We randomized a total of 100 patients with OP carcinoma and El-Ganzouri’s risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications.

Results

The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26–43] sec vs 60 [52–65] sec; difference, −20 sec [95% confidence interval (CI), −27 to −11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6–9] sec vs 22 [14–25] sec; difference, −13 sec [95% CI, −17 to −10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar.

Conclusion

Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases.

Trial registration

CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.

Résumé

Objectif

L’intubation nasotrachéale est nécessaire pour la chirurgie chez la patientèle atteinte de carcinome oropharyngé, mais elle peut être difficile en raison d’une anatomie déformée, d’une congestion des muqueuses et d’un risque accru de saignement. Dans ces cas, il est préférable d’utiliser une intubation nasotrachéale guidée par bronchoscopie flexible (BF), mais cette modalité a ses limites. Dans cette étude randomisée contrôlée, nous avons cherché à comparer la vidéolaryngoscopie guidée par lame D-BLADE C-MAC® (VL) (Karl Storz SE & Co. KG, Tuttlingen, Allemagne) à la BF pour réaliser l’intubation nasotrachéale sous anesthésie générale chez les patient·es ayant un carcinome oropharyngé.

Méthode

Au total, nous avons randomisé 100 personnes atteintes d’un carcinome oropharyngé et présentant un indice de risque d’El-Ganzouri (EGRI) < 7 à bénéficier d’une intubation nasotrachéale sous anesthésie générale par BF (n = 50) ou par VL guidée par lame D-BLADE C-MAC (n = 50). Le critère d’évaluation principal était le temps d’intubation total. Nous avons également enregistré le temps écoulé jusqu’à la visualisation de la glotte, le score sur l’échelle de difficulté de l’intubation nasale (NIDS), le meilleur pourcentage de score d’ouverture de la glotte et les complications.

Résultats

La durée totale d’intubation médiane [écart interquartile (ÉIQ)] était plus courte avec la VL qu’avec la BF (durée totale d’intubation, 38 [26–43] sec vs 60 [52 à 65] secondes; différence, −20 sec [intervalle de confiance (IC) à 95 %, −27 à −11]; P < 0,001). De même, le temps médian [ÉIQ] jusqu’à la visualisation de la glotte était plus court avec la VL qu’avec la BF (8 [6–9] sec vs 22 [14 à 25] secondes; différence, −13 sec [IC 95 %, −17 à −10]; P < 0,001). Le score médian sur l’échelle NIDS était plus élevé avec la VL (différence, 2 [IC 95 %, 2 à 3]; P < 0,001). L’incidence des traumatismes des voies aériennes (deux cas avec la BF vs sept avec la VL; P = 0,30) et le mal de gorge postopératoire (dix cas dans les deux groupes; P = 0,56) étaient similaires.

Conclusion

Par rapport à la BF, la VL guidée par lame D-BLADE C-MAC a réduit le temps total d’intubation nasale pour les personnes atteintes d’un carcinome oropharyngé, ce qui représente potentiellement une alternative acceptable dans certains cas.

Enregistrement de l’étude

CTRI.nic.in (2018/11/0162830); première soumission le 8 novembre 2018.

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Author contributions

Nishkarsh Gupta contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Abhishek Kumar contributed to the acquisition of data and drafting of the article. Tanvi Bhargava, Anju Gupta, Vinod Kumar, Sachidanand Jee Bharti, Rakesh Garg, Seema Mishra, Sushma Bhatnagar, and Rajeev K. Malhotra contributed to the study conception and design, interpretation of data, and drafting of the article.

Disclosures

None.

Funding statement

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Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Medanta Hospital, Lucknow, Uttar Pradesh, India

    Abhishek Kumar DM

  2. Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India

    Nishkarsh Gupta MD, Vinod Kumar MD, Sachidanand Jee Bharti DM, Rakesh Garg MD, Seema Mishra MD & Sushma Bhatnagar MD

  3. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Tanvi Bhargava MD

  4. Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Anju Gupta MD

  5. Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India

    Rajeev K. Malhotra PhD

  6. Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India

    Nishkarsh Gupta MD

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Kumar, A., Gupta, N., Bhargava, T. et al. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anesth/J Can Anesth 71, 503–510 (2024). https://doi.org/10.1007/s12630-023-02687-w

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