The efficacy of Video-Assisted Fibreoptic Intubation compared to bougie-directed tracheal intubation in adult patients undergoing video laryngoscopy for elective surgeries: a single-blinded randomized controlled trial

During general anaesthesia for surgical procedures, patient’s breathing will be maintained by fixing an endotracheal tube inside the airway, which will be visualized using a laryngoscope. Video laryngoscope is one such instrument used for intubating a difficult airway. Various adjuncts can be used as a guide to locate the trachea like bougies and stylets. However, these adjuncts have the disadvantage of limited mobility and flexibility. Video-assisted Fibreoptic Intubation (VAFI) is a newer technique with combined use of fibreoptic scope and video laryngoscope. Not much research is available on comparison these methods in Indian population. This study compares the efficacy of VAFI compared to bougie guided endotracheal intubation using video laryngoscopy.

All patients undergoing general anaesthesia will be screened using inclusion criteria like age>18 years, ASA PS 1-II, and normal BMI. Older patients, emergency surgeries, critically ill and pregnant patients will be excluded from the study. Participants will be blinded and divided into 2 groups. After written informed consent, standard institutional protocol for general anaesthesia will be followed. Intubation will be done using video laryngoscopy with VAFI or bougie as adjunct depending on the assigned group. Efficacy of the adjuncts will be compared using time taken to intubate, success at first attempt, number of attempts at intubation, evidence of airway injury and hemodynamic changes after the procedure.

Data will be collected during the study period of 18 months. Following this, data analysis will be done to identify the superior method in terms of shorter intubation time, higher first attempt success rates, lesser number of attempts, and lesser incidence of airway injury and hemodynamic variability. This study would help in choosing a better guide for intubation which could be extrapolated for use in difficult airways. Limitations of this study include performer bias and need for assistant during the procedure.