A comparison of intubation success in difficult intubation cases: The use of a Frova intubation catheter versus a Bonfils intubation fiberoscope

The Bonfils fiberscope (BF) (Karl Storz, Tuttlingen, Germany) is a hard, long, thin device, with a curved end. During intubation, a tracheal tube (TT) is placed in the shaft of the (BF) and inserted into the patient’s mouth. The Frova Intubating Introducer (FC) (Cook U.K. Limited, Letchworth, Hertfordshire, U.K.) was introduced into clinical practice in 1998. The (FC) is a gum flexible bougie and offers improved endotracheal intubation. Its distal tip bends anteriorly at 30°, thereby improving endotracheal biting of the instrument and allowing the instrument to be used with ease and without trauma. Patients were undergoing elective surgical procedures requiring tracheal intubation, and had been involved in at least one intubation attempt that had been deemed unsuccessful and was performed by an anaesthetist who has at least three years of experience were randomized to tracheal intubation with the Macintosh laryngoscope (size 3 blade in females; size 4 in males) used with the Frova intubation catheter (Group FC) or the Bonfils intubation fiberscope (Group BF). In cases when intubations could not be carried out with the chosen device at the third attempt by an anaesthetist with at least three years of experience, the device was considered to be unsuccessful and intubation was attempted with the second device. When this method also proved unsuccessful, airway management based upon the difficult airway algorithm was maintained. As a third method, the combined use of both devices or intubation with a fibreoptic bronchoscope was preferred.