Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Awake nasotracheal intubation with a 300-mm working length fiberscope: a prospective observational feasibility trial

Intubação nasotraqueal do paciente acordado com um fibroscópio de 300 mm de comprimento de trabalho: um estudo de viabilidade observacional prospectivo

Ioan Florin Marchis, Claudiu Zdrehus, Sever Pop, Doinel Radeanu, Marcel Cosgarea, Calin Iosif Mitre

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Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases.

This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients’ periprocedural satisfaction and other incidents were recorded.

We successfully intubated all 25 patients included in this study. The mean ±SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 – mild discomfort. No significant incidents occurred.

Our study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways.


Airway management;  Endoscopy;  Endotracheal intubation;  Local anesthesia;  Patient satisfaction



A intubação traqueal com fibra óptica do paciente acordado é um método estabelecido para proteger vias aéreas difíceis, mas há algumas reservas sobre seu uso porque muitos profissionais consideram-no tecnicamente complicado, demorado e desagradável para os pacientes. Nosso principal objetivo foi testar a segurança e eficácia de um fibroscópio de comprimento útil de 300 mm (videorinolaringoscópio) quando usado para intubação nasotraqueal acordado em casos de vias aéreas difíceis.


Este foi um estudo prospectivo, unicêntrico, envolvendo pacientes adultos, com estado físico ASA entre I e IV, com patologia laringofaríngea causando anatomia distorcida das vias aéreas. A intubação nasotraqueal acordada, com anestesia tópica e sedação leve, foi realizada com fibroscópio de 300 mm de comprimento e 2,9 mm de diâmetro equipado com tubo endotraqueal reforçado lubrificado. Os resultados primários foram o sucesso e a duração do procedimento. A satisfação periprocedimento dos pacientes e outros incidentes foram registrados.


Intubamos com sucesso todos os 25 pacientes incluídos neste estudo. A duração média ± DP do procedimento, desde a passagem do tubo de intubação por uma das narinas até a intubação endotraqueal, foi de 76 ± 36 segundos. A maioria dos pacientes não apresentou desconforto durante o procedimento com significância estatística entre o Grupo Sem reação com o Grupo Careta Leve (IC95% 0,13; 0,53, p = 0,047) e o Grupo Careta Intensa (IC 95% 0,05; 0,83, p = 0,003). A média ± DP do escore de satisfação 24 horas pós-intervenção foi de 1,8 ± 0,86 – desconforto leve. Não ocorreram incidentes significativos.


Nosso estudo mostrou que um endoscópio flexível de 300 mm de comprimento de trabalho é rápido, seguro e bem tolerado para intubação nasotraqueal acordado sob vias aéreas desafiadoras.


Manejo de vias aéreas; Endoscopia; Intubação endotraqueal; Anestesia local; Satisfação do paciente


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