By Mohamed R El-Tahan, M.D. , Thursday, April 03, 2014
Awake fiberoptic intubation (FOB) necessitates the use of a special conduit such as Ovassapian, Berman, or Williams oropharyngeal airways or Aintree to place the FOB beyond the epiglottic area.
Mohamed R. El-Tahan, Anesthesiology Department, King Fahd Hospital of the University of Dammam, Dammam, Saudi Arabia, P.O. 40289 Al Khubar 31952, Saudi Arabia,
The emerging use of different video laryngoscopes as conduit for the FOB has gained popularity1-4 where the use of FOB alone is unsuitable in some patients with tracheal obstruction, restricted neck movement, or pharyngeal edema or bleeding.
The Glidescope® has been used to facilitate the entrance of FOB into the glottis in patients with critical airway obstruction and bleeding.1 However, its design necessitates that the bronchoscope be introduced on the right side of its blade, potentially limiting the maneuvering of the FOB.4
A channeled video laryngoscope like as the Airtraq®,2 Airway Scope, 3 and King VisionTM 4 facilitates fibreoptic-guided intubation using either a small FOB inserted through the endotracheal tube (ETT) mounted in the guiding channel and then directed into the glottis [Illustration (1)] or by using a large FOB inserted through the guiding channel and directed into the glottis, followed with railroading the ETT over its shaft.
The King VisionTM videolaryngoscope has many advantages. First, it is relatively inexpensive and easy to handle. Second, it offers a 160 degree field of view, potentially eliminating the need for extensive manipulation of the bronchoscope. Third, it is better suited for the tracheal intubation of patients with pharyngeal swellings as it can be used to displace the pharyngeal tissue and may provide superior conduit for the FOB.4
In conclusion, the combined use of the channeled video laryngoscope and a bronchoscope can be an effective method of airway management in selected patients.
1. Xue FS, Li CW, Zhang GH, et al. GlideScope-assisted awake fibreoptic intubation: initial experience in 13 patients. Anaesthesia. 2006; 6:1014–1015.
2. Yuan YJ, Xue FS, Liao X, Liu JH, Wang Q. Facilitating combined use of an Airtraq® optical laryngoscope and a fiberoptic bronchoscope in patients with a difficult airway. Can J Anaesth. 2011; 58:584–585.
3. Asai T, Ito I, Kuremoto Y, Kawashima A. Tracheal intubation with Pentax AWS Airway Scope after failed fiberoptic intubation and failed insertion of the intubating laryngeal mask airway. Masui. 2010; 59:470–472.
4. El-Tahan MR, Doyle DJ, Khidr AM, Abdulshafi M, Regal MA, Othman MS. Use of the King Vision™ video laryngoscope to facilitate fibreoptic intubation in critical tracheal stenosis proves superior to the GlideScope®. Can J Anaesth. 2014;61:213-214.