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Anesth Analg 1999;88:1425
© 1999 International Anesthesia Research Society

LETTERS TO THE EDITOR

Difficult Airway Management with Balloon Inflation

Spyros D. Mentzelopoulos, MD, DEAA(P1), Marina V. Tsitsika, MD, and Evangelia A. Karamichali, MD, PhD

Department of Anesthesia Evangelismos General Hospital Athens, Greece

Forceful, 3-cm anterior elevation (AE) with a conventional curved blade 4 and optimal external laryngeal manipulation (1) resulted in failure to expose the posterior commissure of glottis in two anesthetized patients with anterior larynx. The first attempt at endotracheal intubation failed in both patients.

Preoperatively, the airway of Patient 1 was evaluated as Mallampati class 4 (2,3) with limited neck extension (20°). Patient 2 presented for resection of cervical tumor causing left anterior laryngeal displacement (thyroid prominence palpable 3 cm left-to-midline).

The second endotracheal intubation attempt was successful because we used a modified Macintosh blade (MMB) 4 carrying two 10 Foley catheters (Fig. 1). In Patient 1, the MMB was advanced deep into vallecula, right catheter-balloon inflation with 2 mL of air exposed the arytenoids, and MMB-AE of 1.5 cm revealed the posterior half of glottis. In Patient 2, the MMB tip was placed above the displaced epiglottis, left catheter balloon inflation with 2 mL of air exposed the posterior half of glottis, and MMB-AE of 0.5 cm revealed the entire laryngeal aperture.



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  		Figure 1. The modified Macintosh blade 4. Two 10 Foley catheters are firmly attached on the concave surface of this blade. The right catheter balloon is inflated with 2 mL of air.

 
We conclude that adequate contact between balloon upper surface and structures connected to the epiglottis (base of tongue and hyoid bone) was established by balloon inflation. Consequently, lifting of the epiglottis by MMB-AE and exposure of the glottis were facilitated.

References

  1. Benumof JL, Cooper SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth 1996;8:136–40.[Web of Science][Medline]
  2. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can J Anaesth 1985;32:429–34.
  3. Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487–90.[Web of Science][Medline]



This article has been cited by other articles:


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S. D. Mentzelopoulos, C. N. Romana, D. S. Corolanoglou, M. J. Tzoufi, and E. A. Karamichali
Balloon Versus Conventional Laryngoscopy: A Comparison of Laryngoscopic Findings and Intubation Difficulty
Anesth. Analg., December 1, 2000; 91(6): 1513 - 1519.
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S. D. Mentzelopoulos, M. V. Tsitsika, and E. A. Karamichali
Difficult Airway Management with Fogarty Catheter Balloon Inflation
Anesth. Analg., August 1, 2000; 91(2): 495 - 495.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 1999 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press