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Learning fibreoptic intubation with a virtual computer program transfers to ‘hands on’ improvement

Boet, Sylvaina; Bould, M Dylanb; Schaeffer, Rolanda; Fischhof, Simona; Stojeba, Nathaliea; Naik, Viren Nc; Diemunsch, Pierrea,c

European Journal of Anaesthesiology (EJA): January 2010 - Volume 27 - Issue 1 - p 31–35
doi: 10.1097/EJA.0b013e3283312725
Airway Management

Background and objective Fibreoptic intubation is an essential skill in anaesthesiology that is challenging to learn in the clinical setting. The goal of this study was to evaluate ‘virtual fibreoptic intubation’ (VFI) software as an adjunct to the traditional fibreoptic intubation teaching.

Methods After informed consent, 42 undergraduate medical students were randomized into two groups. The ‘control group’ was taught conventionally by an expert bronchoscopist with a 1 h lecture. In addition to the didactic lecture by the expert, the ‘VFI group’ was given the VFI CD-ROM, and students self-trained with the software until they felt competent performing a virtual fibreoptic bronchoscopy on the normal patient models. Students were evaluated 2 weeks later on their first orotracheal fibreoptic intubation of an airway manikin. The primary endpoint was success, as evaluated by a staff anaesthesiologist blinded to the group of teaching. Fibreoptic intubation ability was the secondary endpoint.

Results The fibreoptic intubation success rate was significantly higher in the VFI group than in the control group (81 versus 52%, P < 0.05). Among 10 failures in the control group, nine were due to oesophageal intubation as compared with only one out of four in the VFI group. Among four failures in the VFI group, three were because of taking longer than 4 min as compared with only one out of 10 in the control group. The VFI group tended towards better ability in the procedural skills of fibreoptic intubation than the control group.

Conclusion Self-training in fibreoptic intubation with the VFI software may improve the acquisition of fibreoptic intubation skills.

aDepartment of Anesthesia and Critical Care, Hôpital de Hautepierre, University of Strasbourg, Strasbourg, France

bDepartment of Anesthesia, Hospital for Sick Children, University of Toronto, Canada

cDepartment of Anesthesia, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Received 19 May, 2009

Revised 19 July, 2009

Accepted 21 July, 2009

Correspondence to Pierre Diemunsch, Department of Anesthesia and Critical Care, University of Strasbourg, Hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France Tel: +33 3 88 12 70 76; fax: +33 3 88 12 70 74; e-mail:

© 2010 European Society of Anaesthesiology