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LETTERS TO THE EDITOR

Fiberoptic Orotracheal Intubation in the Left Semilateral Position

Medical Clinic of Kumagaya Base, National Defense Medical College, Kumagaya City, Japan Medical Corps of 1st Wings, Japan Air Self Defense Force, Hamamatsu City, Japan Department of Anesthesia, Self Defense Force Hanshin Hospital, Kawanishi City, Japan

To the Editor:

Endotracheal intubation in the left lateral position is still recommended by some authorities (1,2). The left lateral position prevents the laryngeal structure from collapsing, and this position is recommended in adult basic life support (3). We assessed the usefulness of semilateral positioning for visualizing the larynx during fiberoptic orotracheal intubation.

After obtaining approval from the Division Ethics Committee of the IRB and written informed consent, 50 scheduled surgical patients were studied. After inducting anesthesia and confirming adequate mask ventilation, we inserted the fiberoptic bronchoscope (FOB) into the patient’s larynx in the common supine position without assistance, in the supine position with assistance that consisted of holding the lower jaw upward, and in the left semilateral position using a soft pillow under the right side of the back and rotating the head of the patient naturally to the left (Fig. 1). The degree of visualization of the laryngeal structure was evaluated using the classification of Aoyama et al. (4). In the supine position, visualizing the glottis through the FOB was impossible in 44 patients (88%) (Table 1), whereas visualizing the glottis was easy in 41 patients (82%) in the semilateral position.

View larger version (98K): [in this window] [in a new window]   Figure 1. A view of the left semilateral position immediately before intubation. The patient’s neck naturally turns to the left and the fiberoptic bronchoscope is inserted through the mouth. The patient was Yushi U. Adachi, MD himself during induction of anesthesia for neurinoma surgery.

References

1. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care, II: Adult basic life support. JAMA 1992; 268: 2184-98.[Abstract/Free Full Text]
2. Ovassapian A. Fiberoptic endoscopy and the difficult airway. 2nd ed. Philadelphia: Lippincott-Raven, 1996.
3. Morris IR. Fibreoptic intubation. Can J Anaesth 1994; 41: 996-1008.[Web of Science][Medline]
4. Aoyama K, Yamamoto T, Takenaka I, et al. The jaw support device facilitates laryngeal exposure and ventilation during fiberoptic intubation. Anesth Analg 1998; 86: 432-4.[Web of Science][Medline]
5. Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487-90.[Web of Science][Medline]
6. Adachi YU, Takamatsu I, Watanabe K, et al. Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring: comparison with conventional direct laryngoscopy. J Clin Anesth 2000; 12: 503-8.[Web of Science][Medline]
7. Kanaya N, Nakayama M, Seki S, et al. Two-person technique for fiberscope-aided tracheal intubation in a patient with a long and narrow retropharyngeal air space. Anesth Analg 2001; 92: 1611-3.[Free Full Text]

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