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Anesth Analg 2000;91:495
© 2000 International Anesthesia Research Society

LETTERS TO THE EDITOR

Difficult Airway Management with Fogarty Catheter Balloon Inflation

Spyros D. Mentzelopoulos, MD, Marina V. Tsitsika, MD, and Evangelia A. Karamichali, MD, PhD

Department of Anesthesiology Evangelismos General Hospital Athens, Greece

A curved blade 4 carrying a 6F Fogarty catheter (Fig. 1) [a "less bulky" refinement of a previously described modified blade (1) suggested by an Anesthesia & Analgesia Editorial Board Member] was used to improve laryngeal exposure in an anesthetized patient with feasible mask ventilation and a simplified airway risk index score (2) of 6 [Mallampati class >= III (2–4), definite difficult intubation history (2), and neck movement <80° (2)].



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  		Figure 1. The modified curved blade 4 with a 6F Fogarty catheter attached on the midline of its concave surface. The Fogarty catheter balloon is inflated with 1.5 mL of air.

 
Initially, forceful laryngoscopy with a Macintosh blade 4 and external hyoid pressure resulted in visualization solely of the epiglottis tip and inadvertent esophageal intubation. Laryngoscopy was then repeated with the new modified blade. After epiglottis tip-visualization, the Fogarty catheter balloon was inflated with 1.5 mL of air, resulting in full epiglottis-visualization. The blade was advanced deep into the vallecula and elevated forcefully, resulting in exposure of the arytenoids’ muscular processes, and a 6.0 endotracheal tube was advanced tangentially to the epiglottis-laryngeal aspect and toward the arytenoids and placed into the trachea.

We conclude that the Fogarty catheter-balloon inflation facilitated both the blade insertion into the vallecula by displacing the tongue-base upwardly and the epiglottis-lifting as a result of adequate contact between the balloon’s upper surface and the structures connected to the epiglottis (tongue-base and hyoid) (1).

References

  1. Mentzelopoulos SD, Tsitsika MV, Karamichali EA. Difficult airway management with balloon inflation [letter]. Anesth Analg 1999;88:1425–6.[Free Full Text]
  2. El-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996;82:1197–204.[Abstract]
  3. 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.
  4. 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.
[Abstract] [Full Text] [PDF]

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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 2000 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press