8/10/2019 JR fibro scope.pdf

1/2

Iranian Journal of OtorhinolaryngologyVol. 22, No.61, Autumn-2010,

Received date: 11 May 2010 Accepted date: 26 Aug 2010

1Department of anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran2

Ear, Nose, Throat, Head and Neck surgery Research Center , Mashhad University of Medical Sciences, Mashhad, Iran*Corresponding author :Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Email: Bakhshaee@mums.ac.ir, Tel: +985118022517, Fax: +985118594082

159

An Airway which Facilitates intubation with a Fiberoptic Laryngoscope

Ali Reza Bameshki 1, *Mehdi Bakhshaee 2

L etter to Editor

Fiberoptic laryngoscope (FL) is often usedwhen there is the probability of difficultintubation. In addition to facilitating

intubation it also reduces the risk oflaryngoscope-induced complications suchas trauma and airway edema. It is mostlyutilized when the patient is awake andunder the influence of local anesthesia andmild sedation; this is because by reservingspontaneous respiration, besidesmaintaining adequate oxygenation itfacilitates fiberoptic laryngoscopy andintubation(1).

In some cases due to the lack of patientcooperation or discovering a difficulty inintubation during laryngoscopy, it is doneunder general anesthesia. In suchconditions because of muscular relaxationand tongue retraction, in addition to therisk of hypoxia during laryngoscopy,working with FL becomes harder and willnot give a clear visual pathway; especiallywhen oral intubation is the case.

In such circumstances in order to lift thetongue and prepare a clear visual pathwayit is better to use an oropharyngeal airway(such as Williams, Ovassapian or BermannII) or an intubating LMA. In this aspect weintroduce a new type of airway whichfacilitates fiberoptic laryngoscopy and

endotracheal intubation. This airway is amodified type of the commonoropharyngealairway, which its right side is dissected

(Fig1). In an anesthetized patient afterinserting the airway into his mouth andfixing it in the middle line, the fiberopticlaryngoscope is guided downwardsthrough its tube (Fig 2). After seeing theterminal section of the airway it isadvanced 1-2 cm further till the glottiscomes into view, passes by it and reachesthe carina; then the fiberopticlaryngoscope cord is released from theright side of the airway which has beendissected (Fig 3) and the airway is takenout of the patient's mouth.

Fig 1. The shape of the device with a right-sided groove.

Short Paper

8/10/2019 JR fibro scope.pdf

2/2

An Airway which Facilitates Intubation with a Fiberoptic Laryngoscope

160 Iranian Journal of Otorhinolaryngology Vol. 22, No.61, Autumn-2010,

Afterwards, the endotracheal tube whichthe fiberoptic laryngoscope has beeninitially placed in is gently inserted in thetrachea and the fiberoptic laryngoscope is

then removed.

This technique was performed on many patients and resulted in highly facilitatedfiberoptic laryngoscopy and intubation.The major positive point of using thisairway is that it could be prepared in any

operating room with consuming very littleamount of time.

Fig 2. The device while the laryngoscopecomes through it.

Fig 3. Extraction of the laryngoscope from theright-sided groove device.

References:

1. John Henderson. Airway management in the adult. Millers anesthesia. 7 th ed. 2010:1592-4.