Clinical competence in the performance of fiberopt laryngoscopy and endotracheal intubation: A study of resident instruction

Anesthesiologists must be competent in the technique of fiberoptic laryngoscopy and intubation in airway management. The goal of this study was to test the hypothesis that an acceptable level of technical expertise in fiberoptic laryngoscopy and intubation may be acquired within 10 intubations while maintaining patient safety. The learning objectives were an intubation time of 2 minutes or less and greater than 90% success on the first intubation attempt. Ninety-one ASA physical status I–II patients with normal laryngeal anatomy had general anesthesia and were intubated orally with an Olympus LF-1 fiberoptic scope; the mean (± SD) time for intubation was 1.92 ± 1.45 minutes. Four residents with no prior experience with fiberoptic laryngoscopy intubated at least 15 patients each. A learning curve was generated using logarithmic analysis of the mean (± SD) time for intubation of patients 1 to 15 for all residents combined. The curve showed that the mean (±SD) intubation time decreased from 4.00 ± 2.91 to 1.53 ± 0.76 minutes within the first 10 intubations. After the tenth intubation, the mean time was 1.53 minutes and the percent success on the first attempt at intubation was greater than 95%. There were no clinically important changes in 02 saturation, mean arterial pressure (MAP), or heart rate (HR) as a consequence of fiberoptic intubation. The results suggest that an acceptable level of technical expertise in fiberoptic intubation can be obtained (as defined by the learning objectives) by the tenth intubation, and patient safety is maintained. Directors of anesthesia residency training should consider these data in determining training protocols for teaching fiberoptic laryngoscopy and intubation.