Using a shortened uncuffed endotracheal tube as a nasopharyngeal airway: a useful adjunct during fiberoptic intubation training among anesthesia residents

Background: Fiberoptic intubation (FOI) is considered a beneficial modality used to intubate life-threatening airway patients.This study aims at assessing the effectiveness of shortened uncuffed endotracheal tube as a nasopharyngeal airway during FOI. Methods: Between January 2019 and March 2021, this prospective randomized controlled trial has enrolled 62 adult patients(56 males and 6 females) with normal airways scheduled for elective oral FOI classified American Society of Anesthesiologists(ASA I-III), their age ranged 20-60 years. The patients were randomized into two equal groups (31 per each); in group I, FOIwas carried using lingual traction, and in group II, FOI was carried out with lingual traction plus a shortened uncuffed endotrachealtube as a modified nasopharyngeal airway to maintain oxygenation. The time taken to successful tracheal intubation andother technical parameters have been measured. The heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2),end-tidal carbon dioxide (EtCO2), and any associated complications have been measured. Results: During insertion of the scope, the SpO2 was significantly decreased in group I (92.55 ± 7.94) compared to group II(97.42 ± 6.34), p=0.009. The heart rate, MAP, and EtCO2 were found to be insignificantly different in both groups (p>0.05).The time needed for intubation in group I (2.78±0.98 min) was prolonged compared with group II (1.95±1.02 min) p =0.002.The number of attempts was comparable in both groups, while the number of successful intubations from the 1st attempt was12 (39%) compared to 18 (58%) in groups I and II respectively, p=0.36. The overall success rate by juniors was 71% in group Icompared to 84% in group II, p=0.66 with a lower incidence of using rescue oxygen and other facilitating maneuvers. Conclusions: The modified nasopharyngeal airway is a useful modality to facilitate oral FOI by anesthesia resident trainees. Keywords: Nasopharyngeal airway; Endotracheal tube; Training of FOI.