The UpsherScope(TM) in routine and difficult airway management: A randomized, controlled clinical trial

The UpsherScope(TM), a rigid fiberoptic laryngoscope, may facilitate tracheal intubation. We performed a randomized, controlled trial of tracheal intubation using the UpsherScope(TM) and compared the success rate with that of direct laryngoscopy. Three hundred patients were randomly assigned to either fiberoptic oral intubation using the UpsherScope(TM) (Group US, n = 148) or to direct laryngoscopy (Group DL, n = 152). No significant differences in airway variables were observed between the groups. US intubation was successful in 129 of 148 patients (87%). A second or third attempt was required in 15% and 3%, respectively, of the patients successfully intubated with US. The remaining patients were intubated using DL (n = 17) or the flexible fiberoptic bronchoscope (n = 2). The success rate of DL was significantly higher (97%; P < 0.05), with a second or third attempt required in only seven patients. Time needed to perform successful intubation was 50 +/- 41s for the US group compared with 23 +/- 13 s for the DL group (P < 0.05). We found no advantage of the UpsherScope(TM) over direct laryngoscopy during routine and difficult airway management. Time needed, number of attempts required to perform intubation, and incidence of failure were significantly longer and higher in group US. Implications: We studied tracheal intubation using the fiberoptic UpsherScope(TM) and compared the success rate with that of a control group of patients intubated using conventional laryngoscopy. No advantages of the new device were found. On the contrary, time needed, number of attempts required, and incidence of failure were even longer and higher.