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Last Updated 3/14/07
Fiberoptic Bronchoscopy Intubation Video

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Difficulty advancing the ETT in this video is caused by allowing inadequate time for relaxation with residual laryngeal reactivity. With time this resolves. It is also common (40% - 90% of cases with regular ETTs) for the tip of the ETT to engage the right vocal cord making advancement of the ETT impossible. When this happens, it is recommended to withdraw the ETT slightly and rotate it clockwise about 90 degrees to rotate the bevel towards the greatest glottic aperture. Repeat this if necessary. Caution is advised because excessive force during advancement attempts does risk injuring the larynx. Other strategies to reduce the incidence of this occurring include using the smallest tube size that will fit over the scope so there is the least amount of "chatter" or looseness between the scope and ETT or use a "pencil-tip" or "self-centering" ETT, such as the Parker Medical ETTs. These ETT tips curve towards midline and are unlikely to engage any tissue folds.

The fiberoptic bronchoscope (FOB) is a flexible device and as such cannot be used to move tissues.  An expensive device, it is re-used after sterilization but there have been reports of infection caused by improper sterilization of FOBs.  FOBs are also fragile (especially the glass fiber).  It has traditionally been the gold standard for management of the difficult airway   It requires a different grip (dagger grip) from direct laryngoscopy and the steering is complex.  It cannot be used instantly because it requires set-up (focus, view orientation and camera) and is not universally available.  The learning curve is prolonged requiring 45 uses to achieve expert skill status.