Safety and ease of awake fiberoptic intubation with use of oxygen insufflation versus suction to clear secretions during procedure

Background and Aims: During awake fiberoptic intubation (AFOI), clearing secretions is usually done by suctioning. The study objectives were to assess the safety of AFOI with the use of oxygen insufflation versus suction to clear secretions from the field of vision during the procedure as assessed by incidence of desaturation <95%, ease of intubation, and time taken to secure the airway. Material and methods: This prospective randomized study was conducted in 40 adult patients with difficult airways requiring AFOI. All patients received dexmedetomidine 0.5mcg/kg intravenously, and the airway was topicalized. In Group-S suction and in Group-O oxygen was connected to the suction port of the bronchoscope to clear the secretions by activating the suction knob during bronchoscopy. Ease of intubation was scored as easy, moderate, and hard. Results: Incidence of desaturation to <95% and the need for oxygen supplementation were significantly high in Group S compared to Group O (60% vs. 10%). Incidence of easy intubation (80% vs. 75%) and time taken to intubate (50.1 +/- 16.6 vs. 53.8 +/- 21.0 s) were comparable. The number of times (median) suctioning was done in Group S was significantly high compared to the number of oxygen insufflations required in Group O [3 (1-6) vs. 2 (0-5), P 0.033]. Desaturation to <95% was significantly low in Group O compared to Group S during bronchoscopy (10% vs. 60%, P 0.002). Conclusion: The use of oxygen insufflation to clear secretions from the field of vision during AFOI is a safer alternative to suctioning as this technique reduces the chance of desaturation during the procedure without affecting ease of intubation, number of attempts, time taken for it, or patient comfort.