Teaching fibreoptic nasotracheal intubation with and without closed circuit television

We have compared the progress of anaesthetists taught fibreoptic nasotracheal intubation with the aid of a closed circuit television (CCTV) system with that of anaesthetists taught by traditional methods. Twenty anaesthetists were allocated randomly to either the video or traditional training group. A graduated training programme was used in which the first stage was an introduction to techniques and apparatus and the second stage was practice on an airway model. During the third stage, rhinoscopy, pharyngoscopy and laryngoscopy were performed on anaesthetized patients whose lungs were ventilated via an orotracheal tube. A maximum time of 6 min was allowed for completion of laryngoscopy. Trainees aimed to perform five endoscopies in less than 60 s before moving on to the next stage. During the fourth stage, they carried out five traditional nasotracheal intubations (plus two video-controlled intubations for the video group) on apnoeic, anaesthetized patients. The mean number of endoscopies required (11.7 vs 21.8), mean total endoscopy time (21.5 vs 63.1 min) and mean number of failed endoscopies (0.8 vs 3.9) were significantly less in the video group. All the video-controlled intubations were successful. There was no significant difference between the number of successful traditional intubations in the two groups (90% video, 92% traditional). CCTV appears to enhance substantially the rate of acquisition of fibreoptic nasotracheal intubation skills.