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Direct Laryngoscopy with the Aid of a Fiberoptic Bronchoscope for Tracheal Intubation

1996; Lippincott Williams & Wilkins; Volume: 82; Issue: 2 Linguagem: Inglês

10.1097/00000539-199602000-00069

1526-7598

J. Eric Haas, Kentaro Tsueda,

Restraint-Related Deaths

To the Editor: Direct laryngoscope blades with fiberoptic vision may permit anesthesiologists to use their expertise in direct laryngoscopy, allowing prompt placement of the lens for fiberoptic visualization of larynxes hidden from direct view. The blade would, at the same time, align oral, pharyngeal, and laryngeal axes for tracheal intubation. We performed laryngoscopy using the Miller blade and a fiberoptic bronchoscope (Olympus BF P20 Registered Trademark; Olympus Corp., Lake Success, NY) for tracheal intubation in 85 ASA grade I-III patients. The lens of the bronchoscope had a 120 degrees forward field view and a fixed focus of 3-55 mm. The lens was positioned in the midline on the posterior surface approximately 12 mm proximal to the distal end of the blade and was aimed at a point in the midline approximately 10 mm posterior to the tip of the blade on the transverse plane. The bronchoscope was taped in this position with a strip of plastic tape Figure 1. The fiberoptic image was displayed on a video screen. We used a tracheal tube introducer (Eschmann Healthcare, Kent, England) in all patients. A tracheal tube was advanced over the introducer with a clockwise rotation. The laryngoscope blade was then removed. Cricoid pressure was not applied.Figure 1: The Miller 4 blade with a fiberoptic bronchoscope assembly.The predictive values of modified Mallampati pharyngeal visibility classification [1] were 81.8%, 58.7%, and 58.8% for the classifications I, II, and III, respectively. The fiberoptic laryngeal visibility was significantly better than direct laryngeal visibility (P < 0.0001 by the test of symmetry) Table 1. Seventeen patients had the Mallampati direct laryngeal visibility classification III and IV [2], and the glottis could not be visualized by direct vision. Fiberoptic laryngeal visibility classification was I in all of the 85 patients. The entire glottis was displayed on the video screen without exception, and the trachea was intubated on the first trial in all patients. There were no significant differences in the times required for tracheal intubation between pharyngeal visibility classifications (20.4 +/- 7.3 s, 20.4 +/- 7.3 s, and 22.7 +/- 7.5 s for the classification I, II, and III, respectively). The addition of fiberoptic visual capability to direct laryngoscope blades may be a useful modification for tracheal intubation.Table 1: Preoperative Pharyngeal Visibility, Direct Laryngeal Visibility, and Fiberoptic Laryngeal Visibility in 85 PatientsJ. Eric Haas, MD Kentaro Tsueda, MD Department of Anesthesiology University of Louisville School of Medicine Louisville, KY 40292