Practical aspects and training in fibreoptic intubation

Flexible fibreoptic bronchoscopy has been an integral part of difficult airway management since it was first described in 1967. Since then, its use has evolved alongside the development of new drugs, practices and airway equipment. This article firstly aims to highlight the assessment of the difficult airway and to evaluate the role of fibreoptic intubation in the anticipated or unanticipated difficult airway. Secondly, we review the current evidence for the practical aspects of fibreoptic intubation, including manipulation of the scope, airway topicalization and sedation as well as tips for overcoming technical problems. Subsequently, our article addresses the importance of education and training in fibreoptic intubation, the lack of which have been shown in the UK's 4th National Audit Project to be contributory factors in major airway complications [1]. Finally, we discuss ethicolegal concerns relating to consent for training and justification of non-routine intubation techniques.