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LETTERS TO EDITOR
Year : 2023  |  Volume : 17  |  Issue : 1  |  Page : 126-127

Use of laryngoscope blade as a rescue intubating airway during fiberoptic orotracheal intubation


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India

Correspondence Address:
Amarjeet Kumar
Room No 505, B-Block, OT Complex, All India Institute of Medical Sciences, Patna - 801 507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_475_22

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Date of Submission28-Jun-2022
Date of Decision28-Jun-2022
Date of Acceptance29-Jun-2022
Date of Web Publication02-Jan-2023
 


How to cite this article:
Kumar A, Singh K. Use of laryngoscope blade as a rescue intubating airway during fiberoptic orotracheal intubation. Saudi J Anaesth 2023;17:126-7

How to cite this URL:
Kumar A, Singh K. Use of laryngoscope blade as a rescue intubating airway during fiberoptic orotracheal intubation. Saudi J Anaesth [serial online] 2023 [cited 2023 Feb 1];17:126-7. Available from: https://www.saudija.org/text.asp?2023/17/1/126/364858



Fiberoptic-guided endotracheal intubation is a commonly used procedure and has become life-saving in difficult airway situation.[1] Even with fiberoptic bronchoscopy, the visualization of glottis sometimes become very difficult. Possible mechanism of poor visualization of glottis is an upper airway structure preventing advancement of the bronchoscope.[2] Various intubating oral airways (IOA) have been designed to improve the bronchoscopic visualization of glottis and for fiberoptic-guided orotracheal intubation.[3] Berman and Ovassapian intubating airways are the most commonly used intubating airways during fiberoptic-guided orotracheal intubation.[4] These airways help to remove visual obstruction due to the tongue and posterior pharyngeal structures and hence making a clear path, provide a firm hold of the bronchoscope in the midline, prevent the patient from biting the insertion cord and provide a patent airway for spontaneously or mask ventilated patient.[5] Here we described a novel use of laryngoscope blade (Macintosh size 2) to remove visual obstruction due to the upper airway structures and to provide clear passage for the bronchoscope [Figure 1]. In view of the absence of Ovassapian airway in our operating room at the time of fiberoptic guided orotracheal intubation we placed a Macintosh blade size 2 into the oral cavity in place of intubating airway after induction of anesthesia. We successfully intubated our patient via orotracheal route by following the path of Macintosh blade curvature. The use of oral intubating airways has always been beneficial during the fiberoptic guided procedure. The advantages of Macintosh blade used for intubating airway in a sedated patients include, guide the bronchoscope and tracheal tube because of wide flange, length of blade form a path leading to the glottis, laterally open for easy tube removal after intubation, it work as Bite Block to protect the bronchoscope, latex free as made of steel. In comparison to Ovassapian airway, Macintosh blade have longer curvature of which may direct the fiberscope close to the vocal cord. Disadvantages include trauma from blade, instability of blade in midline require an assistant to hold in place.
Figure 1: (a) Ovassapian airway and Macintosh blade, (b) Use of Macintosh blade, (c) Use of Ovassapian intubating airway for the passage of bronchoscope with endotracheal tube

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  References Top

1.
Fasting S, Gisvald SE. Serious intraoperative problems-A five year review of 83844 anesthetics. Can J Anaesth 2002;49:545-53.  Back to cited text no. 1
    
2.
Jackson AH, Orr B, Yeo C, Parker C, Craven R, Greenberg SL. Multiple sites of impingement of a tracheal tube as it is advanced over a fibreoptic bronchoscope or tracheal tube introducer in anaesthetized, paralysed patients. Anaesth Intensive Care 2006;34:444-9.  Back to cited text no. 2
    
3.
Greenland KB, Lam MC, Irwin MG. Comparison of the Williams Airway Intubator and Ovassapian Fibreoptic Intubating Airway for fibreoptic orotracheal intubation. Anaesthesia 2004;59:173-6.  Back to cited text no. 3
    
4.
Greenland KB, Ha ID, Irwin MG. Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients. Anaesthesia 2006;61:678-84.  Back to cited text no. 4
    
5.
Ovassapian A. Fiberoptic tracheal intubation in adults. In: Ovassapian A, editor. Fiberoptic Endoscopy and the Difficult Airway. 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 71-103.  Back to cited text no. 5
    


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