Combined videolaryngoscope and fiberoptic intubation for difficult airways in head and neck surgery: A prospective observational study
Gaetano Ottoveggio, Barbara Verro, Maria Lapi, Carmelo Saraniti
Abstract
ABSTRACT Purpose : Difficult airway management is one of the most critical challenges in anesthesiology, both in elective and emergency situations. Despite technological advances and updated guidelines, these situations continue to pose significant risks. Intubation with combined technique (videolaryngoscope and flexible fiberoscope) has generated increasing interest in the management of difficult airways, but literature is poor regarding its use in general anesthesia, during head and neck surgery. Methods : The prospective observational study involved patients undergoing head and neck surgery at the university hospital between February and December 2024. Patients were selected based on specific criteria, including age over 18 and informed consent. Clinical data, including BMI, comorbidity and anatomical characteristics, were collected prior to surgery. Intubation was performed using a combined technique of video laryngoscopy and flexible fiberoscope under general anesthesia. Results : Thirty patients (12 female and 18 male) were included, with an average age of 53.13 ± 13.33 years. In 7 cases, unplanned difficult intubation was reported. The combined technique was successful in the first attempt in 96.67% of cases, with an average intubation time of 9.56 ± 4.07 seconds. Oxygen saturation remained stable, between 97% and 100%. No post-operative complications were reported. Conclusion : The combined technique of video laryngoscopy and flexible fiberoscope has been shown to be highly effective in managing difficult airways, with a high success rate and no significant complications. Although it requires an experienced team, this technique is a good option to improve the safety and effectiveness of intubation, especially in patients with complex upper airway pathologies.