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LETTER TO THE EDITOR

Endoscope-Assisted Intubation: An Approach to Airway Management

Department of Anaesthesiology, Pain and Perioperative Medicine; Sir Ganga Ram Hospital; Old Rajinder Nagar; New Delhi, India; paygupta{at}yahoo.com

To the Editor:

Many new devices have been introduced to assist in visualizing difficult airways (1–3). We report the use of widely available technology to facilitate management of the difficult airway: a conventional 5.0-mm ID surgical laparoscope connected to a standard light source and a video camera.

With IRB approval and informed consent we randomly allocated 100 patients into two groups: intubation by conventional direct laryngoscopy (group A, n = 50), or laparoscope-assisted intubation (group B, n = 50). After induction of anesthesia and administration of muscle relaxants, group A patients were intubated by direct laryngoscopy with a Macintosh blade. Group B patients also underwent direct laryngoscopy with a Macintosh blade. In both groups, Cormack and Lehane grade (4) was noted at the time of direct laryngoscopy. However, in group B direct laryngoscopy was followed by introduction of the laparoscope alongside the flange of the Macintosh laryngoscope (Fig. 1). The anesthesiologist held the rigid laryngoscope in the left hand and the tracheal tube in the right hand while a technician guided the laparoscope along the flange of the laryngoscope blade. The Cormack and Lehane grade was again determined, based on the image on the laparoscopic monitor (Fig. 2).

View larger version (113K): [in this window] [in a new window]   Figure 1. External view of Macintosh laryngoscope, laparoscope, and endotracheal tube.

View larger version (92K): [in this window] [in a new window]   Figure 2. Passage of endotracheal tube through the glottis.

In group B, the laparoscope improved the Cormack and Lehane grade in 80% of patients with a grade 2 view, and 89% of patients with a grade 3 view. The overall mean time to intubate in group A was 34 s while that in group B was 36 s.

The passage of the endotracheal tube with both devices in the patient’s mouth was not difficult as the endoscope just entered 3–4 cm into the oral cavity. The ability to "look around the corner" allowed a good view of the glottis without aligning oral, pharyngeal, and laryngeal axes. This gives this technique a potential advantage over direct laryngoscopy in difficult adult and pediatric intubations. The widespread adoption of endoscopic surgery has made high-quality laparoscopes readily available in most operating rooms (5). This may prove useful, particularly when other advanced airway equipment is not available.

REFERENCES

1. Bjoraker DG. The Bullard intubating laryngoscopes. Anesth Rev 1990;17:64–70.
2. Sun DA, Warriner CB, Parsons DG, et al. The Glidescope® video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005;94:381–4.[Abstract/Free Full Text]
3. Weiss M, Hartmann K, Fischer JE, Gerber AC. Use of angulated video-intubation laryngoscope in children undergoing manual in-line neck stabilization. Br J Anaesth 2001;87:453–8.[Abstract/Free Full Text]
4. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39:1105–11.[Web of Science][Medline]
5. Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487–90.[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Gupta, A. K. Articles by Sood, J. Search for Related Content PubMed PubMed Citation Articles by Gupta, A. K. Articles by Sood, J.