|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 4 | Page : 197-198
Combination use of laryngoscope, jaw thrust, and trachway for improving difficult tracheal intubation in obese
Wei-Chieh Chiu1, Zhi-Fu Wu2, Meng-Fu Lai1, Hou-Chuan Lai1
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 Submission||19-Oct-2020|
|Date of Decision||30-Nov-2020|
|Date of Acceptance||30-Nov-2020|
|Date of Web Publication||03-Feb-2021|
Dr. Hou-Chuan Lai
#325, Section 2, Chenggung Road, Neihu 114, Taipei
Source of Support: None, Conflict of Interest: None
|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
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., 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, because the tongue and epiglottis tend to move toward the posterior pharyngeal wall in the supine position in anesthetized patients, especially in obese patients. Wu et al. 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. In addition, Saruki et al. 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. 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. 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. Finally, a 70° angle stylet is suggested for Trachway or Glidescope for facilitating intubation.,
|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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We thank the patient for signing the informed consent for publication.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]