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Abstract
Though a great number of instruments for safe airway management in
anesthesiology, intensive care, and emergency medicine have been introduced in
recent years, endotracheal intubation continues to be the unchallenged gold
standard. The severity of possible complications is reflected in the statistical
mortality and morbidity figures identifying hypoxic brain damage due to
inadequate airway management as one of the main causes of anesthesia-related
fatalities.
For this reason, early detection of intubation difficulties is one of the most
significant tasks of the anesthetist and if the patient is likely to prove difficult to
intubate, fiberoptic intubation can considerably reduce the risk of hypoxia; it
allows the anesthetist to conduct the procedure in a spontaneously breathing,
mildly sedated patient.
The flexible fiberoptic endoscope (FFE) is the most valuable single tool
available to the anesthesiologist faced with a difficult airway.
It should not be regarded simply as a ”Last resort” for emergency cases,
which only a few anesthetists are skilled enough to apply, because multiple
laryngoscopies priorly usually increase secretions, edema, and bleeding that may
transform a simple fiberoptic intubation (FOI) into a time-consuming and
potentially dangerous procedure. Rather all anesthesiologists should know the
basic physical principle of the flexible fiberscopes in which Total internal
reflection (TIR) is the most important phenomenon for the guiding of light in its
fibers. Also they should receive adequate training to be capable of performing a
safe and successful fiberoptic intubation in all patients (pediatrics and adults) using
either oral or nasal approach.