For example, the Bonfils Intubating Fiberscope has a moderate curvature (40°), and therefore requires a retromolar or lateral entry into the hypopharynx. This lateral entry (at an angle across the tongue) is unfamiliar to most anesthesia practitioners, and has another added learning curve to using this instrument. Most anesthesia providers are more accustomed with a midline approach for oral intubations. Inhibitors,research,lifescience,medical Based on the above design and use limitations, the Boedeker intubating fiberscope (Figures ​(Figures11 and ​and2)2) was fabricated

by altering a 15 Fr Bonfils Intubating Fiberscope (KARL STORZ Endoscopy, El Segundo, CA) with a modified angle of 60°. The novel curvature of this fiberscope allows the provider to use the more familiar midline

approach Inhibitors,research,lifescience,medical for intubation. The see more objective of the current study is to compare the newly designed Boedeker intubating fiberscope with the Bonfils Intubating Fiberscope in the intubation of a simulated difficult airway in terms of use and functional characteristics. Figure 1 Comparison of the curvature of the Boedeker vs. Bonfils intubation fiberscopes. The Boedeker fiberscope has a greater curvature of 60°. This more anterior curve, compared Inhibitors,research,lifescience,medical to the Bonfils Intubation Fiberscope (40 degrees), allows it to line up … Figure 2 The Bonfils and Boedeker fiberscopes. Photo shows the Bonfils (top) and Boedeker (bottom) fiberscopes. Methods Following IRB approval, anesthesia providers (n = 22) including anesthesia attending physicians and residents, and Certified Registered Nurse Anesthetists (including one student CRNA) at the University of Nebraska Medical Center and Omaha VAMC, Omaha, NE participated in intubation Inhibitors,research,lifescience,medical of a Laerdal Deluxe Difficult Airway Trainer™ (Laerdal Medical Corporation,

Wappingers Falls, NY) with the tongue inflated to simulate a difficult airway [7]. The providers completed a pre-experience questionnaire assessing prior experience with awake intubation, and their level of training. Prior to the exercise, the instructor demonstrated the use of both fiberscopes. The participants were then observed Inhibitors,research,lifescience,medical during their intubation attempts alternatively using the Bonfils and Boedeker intubating fiberscopes (randomized to eliminate learning Digestive enzyme effects) (Figures ​(Figures11 and ​and2).2). During the study, the following variables were collected: recorded Cormack Lehane (CL) airway score, the time to intubation, the number of intubation attempts, the success/failure of the intubation, and whether or not cricoid pressure was requested by the intubator. The observed view of the glottic opening was graded by the participant using the Cormack Lehane (CL view) grading scale (where Grade I = full view of the glottic opening; Grade II = posterior portion of glottic opening is visible; Grade III = only the tip of the epiglottis is visible; Grade IV = only the soft tissue is visible).