Combined Technique for Difficult Intubation

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Catharina Hospital




Anesthesia Intubation Complication
Failed or Difficult Intubation, Initial Encounter
Failed or Difficult Intubation
Intubation; Difficult


Device: Videolaryngoscope and Bonfils

Study type


Funder types



12-624 (Other Identifier)

Details and patient eligibility


A difficult tracheal intubation can be a problem, even if one has taken all precautions. A possible solution can be using a videolaryngoscope in conjunct with the Bonfils® intubation scope. As such, the videolaryngoscope can be used to achieve the best possible view and space of the laryngeal inlet for the insertion and manoeuvring of the Bonfils® intubation scope.

Full description

In this blinded, unrandomised trial the investigators would like to investigate the change in Cormack and Lehane grade when using both videolaryngoscope (Macintosh videolaryngoscope, Karl Storz, Tuttlingen, Germany) and Bonfils® (Karl Storz, Tuttlingen, Germany). They also want to record the success of intubation and the time needed until successful endotracheal intubation when using this technique as well as complications (trauma to the oral cavity, dental trauma, and regurgitation seen by the anaesthesiologist) that may occur. Also saturation (SpO2) at the end of the procedure will be noted and adjuncts that are used.


40 patients




18+ years old


No Healthy Volunteers

Inclusion criteria

  • Informed patient consent Age > 18 years History of difficult intubation (Cormack and Lehane III-IV)

One or more predictors of a difficult intubation:

  • restricted neck movement
  • thyromental distance < 60 mm
  • interincisor/interdental distance < 30mm
  • BMI > 35 kg.m-2 Elective surgery making endotracheal intubation necessary (other than head and/or neck surgery) Fasted (≥ 6 hours)

Exclusion criteria

  • No informed patient consent Age < 18 years Emergency surgery, head and/or neck surgery Fasted < 6 hours

Trial design

40 participants in 1 patient group

Videolaryngoscope and Bonfils
Experimental group
First, the Macintosh videolaryngoscope (Karl Storz, Tuttlingen, Germany) will be used to achieve the best possible view and space of the laryngeal inlet for the insertion and manoeuvring of the Bonfils® (Karl Storz, Tuttlingen, Germany). Once the anaesthesiologist considers the view achieved to be the best view possible, a picture will be taken using C-CAMTM for C-MAC (Karl Storz, Tuttlingen, Germany), not showing any part of the videolaryngoscope. Thereafter the Bonfils® intubation scope, which will be preloaded with the endotracheal tube, will be brought into position in front of the laryngeal inlet. Again a picture not showing any part of one of the two devices will be taken. Once the Bonfils® has entered the trachea, the tracheal tube will be placed in the correct position.
Device: Videolaryngoscope and Bonfils

Trial contacts and locations



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