Mannan Abdul,1,* Lili Feng,1,* Xiuwen Yi,1 Yan Zhuang,1 Yingjie Wang,1,2 Jiali Jiao,3 Shuang Shuang Li,1 Yuan Han,1 Wenxian Li1 

1Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, People’s Republic of China; 2School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, People’s Republic of China; 3Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wenxian Li; Yuan Han, Department of Anesthesiology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, People’s Republic of China, Tel +86-21-64377134-2955, Fax +86-21-64377151, Email wenxian.li@fdeent.org; yuan.han@fdeent.org

Background: Patients with airway pathologies are at higher risk for difficult intubation, making Awake flexible bronchoscopy intubation (AFBI) an essential technique. This study aimed to describe the baseline characteristics, procedural details, and outcomes of AFBI regarding otorhinolaryngology surgery.
Methods: This single-centre, observational study included 147 adult patients who underwent a standardised AFBI protocol for otorhinolaryngology surgery patients at Eye & ENT Hospital of Fudan University between January 1, 2022 and July 31, 2023. Data were collected from procedural video recordings and clinical database. Baseline characteristics, oxygenation methods, topicalisation, sedation levels, and procedural outcomes were documented. Comparisons between the first-attempt success group and the multiple-attempts success group were further performed.
Results: The median age of the patients was 66.00 years (IQR: 59.00– 70.00), and 85.03% were male. The median body mass index (BMI) was 22.20 kg.m−² (IQR: 19.80– 24.60) and the most common indication for AFBI was pathological obstruction of the supra-glottic region (79.59%). Nasal cannula was the most frequently used oxygenation method (94.56%). The minimum SpO2 during the procedure was 95.00% (IQR: 92.00– 97.00), and median procedure duration was 20.45 minutes (IQR: 18.55– 24.41). Lidocaine was the most commonly used topical anesthetic (78.23%, median dose: 3.27 mg.kg−¹, IQR: 2.79– 3.94), followed by a combination of lidocaine and tetracaine (20.41%). Dexmedetomidine was administered 100% of cases (median dose: 0.71 μg.kg−¹, IQR: 0.51– 0.88), and fentanyl was used in 97.28% of cases (median dose: 0.87 μg.kg−¹, IQR: 0.72– 1.00). One hundred and twenty-eight (87.07%) were successfully intubated on the first attempt, while 19 (12.93%) required multiple attempts. Patients in the multiple-attempts group had a longer procedure duration [23.33 minutes (IQR: 20.80– 26.86) vs 20.01 minutes (IQR: 18.33– 24.09), P = 0.007].
Conclusion: This study highlights the high first-attempt success rate of the optimized AFBI protocol. Tailored airway management strategies are essential, particularly for older patients, to ensure safety and procedural outcomes.

Keywords: ATI, difficult airway, laryngeal obstruction, difficult intubation