Comparison of the glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study

Fibreoptic intubation has long been considered the gold standard intubation technique in patients with an anticipated or known difficulty airway or as a rescue device in failure to intubate but able to ventilate scenarios [1]. Fibreoptic intubation can be a difficult skill to teach, learn and maintain [2]. Since the late 1990’s advances in video technology and fibreoptics has resulted in an increasing number of commercially available video laryngoscopes. Several studies have demonstrated that video laryngoscopes generally provide a better view of the glottis and have higher success rates of intubation compared with the traditional Macintosh blade in patients with a predicted difficult airway. Video laryngoscopes have the additional advantage of less movement of the cervical spine, and are potentially less traumatic; however, these devices may fail secondary to trismus and oropharyngeal tumors, infection or foreign bodies resulting in difficulty inserting the blade. Active bleeding may obscure the view. The presence of airway pathology from previous surgery, a local mass, or radiation treatment are the strongest predictors of Glidescope® failure [3].

Technology is becoming increasingly integrated into medical care. Smart phones, defined as ‘a mobile phone that is able to perform many of the functions of computer devices’, have developed rapidly over the last decade becoming smaller, faster, with improved storage capacity, optical resolution and camera functionality [4]. Reported applications for smart phones as biomedical monitors include interfacing them with oximeters, stethoscopes and microscopes. In anaesthetic practice smart phones have been used for measurement of tilt in obstetric anaesthesia, case log book, aid to resuscitation, education, distraction therapy for children undergoing gas induction, billing, pharmacokinetic modelling and assessment of neuromuscular function [5-7]. Although some of the currently available video laryngoscopes and mobile fibreoptic bronchoscopes can record images and video they are typically more expensive than a smart phone, are larger, may be less available, and lack the telecommunication and data capabilities unique to a mobile phone.

The aim of this study was to assess the usefulness of the iPhone as an adjunct aid to assist in fibreoptic intubation and clinical teaching in a difficult airway scenario when a screen for video-assisted bronchoscopy was unavailable. We recruited non medical anaesthetic personnel to account for variables that may influence performance; including fibreoptic technique, level of experience and familiarity with the iPhone.

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