Video-assisted fiberoptic intubation (VAFI) in patients undergoing general anesthesia for ENT surgery: Use of a videolaryngoscope with guide channel vs. without channel

Purpose: Airway management is a critical aspect of anesthesia, as failed intubation is associated with severe morbidity. The combination of a videolaryngoscope (VL) with a flexible endoscope (FOB), known as video-assisted fiberoptic intubation (VAFI), improves glottic visualisation and endotracheal tube placement. However, evidence comparing VAFI performed with channeled versus non-channeled VLs is limited. This study aimed to compare the effectiveness of these two approaches in a controlled elective setting. Methods: This prospective observational comparative study was conducted at Policlinico Umberto I University Hospital in Rome. Adult patients (ASA I–II) undergoing elective ENT surgery under general anesthesia were enrolled and allocated to two groups according to device availability: Group A (Airtraq channeled VL + FOB) and Group B (C-MAC D Blade non-channeled VL + FOB). The primary outcomes were total intubation time and first-attempt success. Secondary outcomes included intubation difficulty parameters. Results: Thirty-seven patients were included (18 in Group A and 19 in Group B). Baseline characteristics were comparable between groups. Median total intubation time was 52 s in Group A and 44 s in Group B. First-attempt success was achieved in 78% and 79% of patients, respectively (p = 0.999). No statistically significant differences were observed in total intubation times or first-attempt success. Conclusion: Within the limits of this prospective observational study, channeled or non-channeled videolaryngoscopes used as part of a VAFI strategy showed comparable intubation times and first-attempt success rates. When appropriate expertise and resources are available, device selection may reasonably be guided by operator familiarity and equipment availability.