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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 42  |  Issue : 4  |  Page : 197-198

Combination use of laryngoscope, jaw thrust, and trachway for improving difficult tracheal intubation in obese


1 Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
2 Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei; Department of Anesthesiology, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Date of Submission19-Oct-2020
Date of Decision30-Nov-2020
Date of Acceptance30-Nov-2020
Date of Web Publication03-Feb-2021

Correspondence Address:
Dr. Hou-Chuan Lai
#325, Section 2, Chenggung Road, Neihu 114, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmedsci.jmedsci_340_20

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How to cite this article:
Chiu WC, Wu ZF, Lai MF, Lai HC. Combination use of laryngoscope, jaw thrust, and trachway for improving difficult tracheal intubation in obese. J Med Sci 2022;42:197-8

How to cite this URL:
Chiu WC, Wu ZF, Lai MF, Lai HC. Combination use of laryngoscope, jaw thrust, and trachway for improving difficult tracheal intubation in obese. J Med Sci [serial online] 2022 [cited 2022 Aug 16];42:197-8. Available from: https://www.jmedscindmc.com/text.asp?2022/42/4/197/353046



Dear Editor,

Endotracheal intubation is an essential procedure in respiratory failure or general anesthesia. With the development of electronic and optical technology, new instruments for endotracheal intubation have been made for safe and accurate by viewing the larynx with video assistance. Trachway video stylet (Biotronic Instrument Enterprise Ltd., Tai-Chung, Taiwan), also known as the OptiScope, is a semi-rigid fiberoscope with two light sources and a 4-inch LCD monitor, so intubation can be performed while visualizing the patient's larynx through the monitor.[1],[2] However, one of the most common difficult situations encountered during intubation with the Trachway alone is nonvisibility of the vocal cord, due to the tongue base or epiglottis being in contact with the posterior pharyngeal wall,[3] because the tongue and epiglottis tend to move toward the posterior pharyngeal wall in the supine position in anesthetized patients,[4] especially in obese patients. Wu et al.[5] have suggested using jaw thrust maneuver to deal with this problem. However, in obese patients with larger tongue, the larynx may not be lifted by jaw thrust maneuver. By contrast, use of laryngoscope may lift the larynx.[6] In addition, Saruki et al.[7] have reported that the combination of a fiberoptic stylet and a McCoy laryngoscope facilitated tracheal intubation of patients with difficult airway. They also compared the intubation time when the fiberoptic stylet was used with the Macintosh direct laryngoscope (52 ± 8 s) and with the McCoy laryngoscope (28 ± 4 s; P < 0.01) in Cormack grade IIIb patients.[7] It may be due to the longer time required to insert the tube with the fiberoptic stylet beyond the epiglottis, because there is no distance between the epiglottis and the posterior wall of the pharynx in combination use of fiberoptic stylet and the Macintosh direct laryngoscope without jaw thrust [Figure 1]. Here, we suggest the combination use of laryngoscope, jaw thrust, and Trachway for facilitating tracheal intubation in obese based on our clinical experience in difficult airway [Figure 2]. First, conventional laryngoscopy and jaw thrust are familiar core skills in routine clinical anesthesia. Second, about 15 intubations in patients with normal airways provide clinically adequate experience to the skilled anesthesiologists for using Trachway.[8] Accordingly, concurrent use of laryngoscope and Trachway is associated with the fast learning curve by using the laryngoscope to lift the tongue base away from posterior wall of the pharynx and the jaw thrust maneuver to improve the visualized glottis view.[9] Finally, a 70° angle stylet is suggested for Trachway or Glidescope for facilitating intubation.[10],[11]
Figure 1: Monitor view of Trachway while combination use of conventional laryngoscope and Trachway without jaw thrust for difficult intubation in obese

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Figure 2: Monitor view of Trachway while combination use of conventional laryngoscope, jaw thrust, and Trachway for difficult intubation in obese

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Acknowledgment

We thank the patient for signing the informed consent for publication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hung KC. Trachway video stylet use in double lumen tube insertion. Anaesthesia 2015;70:1093-4.  Back to cited text no. 1
    
2.
Ko DD, Kang H, Yang SY, Shin HY, Baek CW, Jung YH, et al. A comparison of hemodynamic changes after endotracheal intubation by the Optiscope™ and the conventional laryngoscope. Korean J Anesthesiol 2012;63:130-5.  Back to cited text no. 2
    
3.
Oh H, Kim H, Yoon HK, Lee HC, Park HP. No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study. BMC Anesthesiol 2020;20:47.  Back to cited text no. 3
    
4.
Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Doré CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth 1991;66:157-62.  Back to cited text no. 4
    
5.
Wu SH, Hsu HT, Cheng KI. Trachway and jaw thrust. Anaesthesia 2014;69:285-6.  Back to cited text no. 5
    
6.
Stacey MR, Rassam S, Sivasankar R, Hall JE, Latto IP. A comparison of direct laryngoscopy and jaw thrust to aid fibreoptic intubation. Anaesthesia 2005;60:445-8.  Back to cited text no. 6
    
7.
Saruki N, Saito S, Sato J, Takahashi T, Tozawa R. The combination of a fiberoptic stylet and a McCoy laryngoscope facilitates tracheal intubation in difficult airway cases. J Anesth 2001;15:132-5.  Back to cited text no. 7
    
8.
Park SK, Yun SH, Park JC, Kim HJ. Learning curve of skilled anesthesiologists for endotracheal intubation using Optiscope™. Anesthesia and Pain Medicine 2017;12:271-4.  Back to cited text no. 8
    
9.
Corda DM, Riutort KT, Leone AJ, Qureshi MK, Heckman MG, Brull SJ. Effect of jaw thrust and cricoid pressure maneuvers on glottic visualization during GlideScope videolaryngoscopy. J Anesth 2012;26:362-8.  Back to cited text no. 9
    
10.
Hsu HT, Lin CH, Tseng KY, Shen YC, Chen CH, Chuang WM, et al. Trachway in assistance of nasotracheal intubation with a preformed nasotracheal tube in patients undergoing oral maxillofacial surgery. Br J Anaesth 2014;113:720-1.  Back to cited text no. 10
    
11.
Lee YC, Lee J, Son JD, Lee JY, Kim HC. Stylet angulation of 70 degrees reduces the time to intubation with the GlideScope®: A prospective randomised trial. J Int Med Res 2018;46:1428-38.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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