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Anesth Analg 2018 Aug;127(2):450-454

Harborview Medical Center, Seattle, Washington.

Background: Airway management in the presence of acute cervical spine injury (CSI) is challenging. Because it limits cervical spine motion during tracheal intubation and allows for neurological examination after the procedure, awake fiberoptic bronchoscopy (FOB) has traditionally been recommended. However, with the widespread availability of video laryngoscopy (VL), its use has declined dramatically. Read More

J Cardiothorac Vasc Anesth 2018 02 9;32(1):267-274. Epub 2017 May 9.

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either a double-lumen tube (DLT) or video double-lumen tube (VDLT) was used for lung isolation during thoracic surgery.

Design: A randomized controlled study.

Setting: Single-center university teaching hospital. Read More

Paediatr Anaesth 2017 Nov 20;27(11):1115-1119. Epub 2017 Sep 20.

Department of Anesthesiology, Jikei University, Minato-ku, Tokyo, Japan.

Background: With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused.

Aim: We aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation.

Methods: We retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. Read More

J Emerg Med 2017 Oct 4;53(4):550-553. Epub 2017 Sep 4.

Department of Emergency Medicine, University of California-Los Angeles, Los Angeles, California.

Background: An obstructive neck lesion presents an airway challenge for any emergency physician. Retrograde intubation is an infrequently used airway alternative that can be employed in the difficult airway algorithm that requires little training and is less invasive than surgical cricothyrotomy.

Case Report: We report a case of a 31-year-old male patient who presented with respiratory distress progressing to respiratory failure from upper airway obstruction. Read More

BMJ Open 2017 Sep 1;7(8):e015307. Epub 2017 Sep 1.

Department of Trauma Surgery and Orthopedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.

Introduction: Emergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Read More

J Emerg Med 2017 Aug 9;53(2):163-171. Epub 2017 Jun 9.

Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, University of Arizona College of Medicine, Tucson, Arizona.

Background: Patients with difficult airways are sometimes encountered in the emergency department (ED), however, there is a little data available regarding their management.

Objectives: To determine the incidence, management, and outcomes of patients with predicted difficult airways in the ED.

Methods: Over the 1-year period from July 1, 2015 to June 30, 2016, data were prospectively collected on all patients intubated in an academic ED. Read More

Indian J Anaesth 2017 Jan;61(1):36-41

Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.

Background And Aims: The difficulty during flexible fiber-optic bronchoscopy (FOB) guided tracheal intubation could be because of inability in visualising glottis, advancing and railroading of endotracheal tube. Several methods are available for visualising glottis, but none is ideal. Hence, this randomised controlled study was designed to evaluate the simple pre-determined length insertion technique (SPLIT) during oral FOB. Read More

J Clin Anesth 2017 Feb 1;36:127-132. Epub 2016 Dec 1.

Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.

Study Objectives: To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia.

Design: Retrospective, observational study.

Settings: Operating room of a university hospital between January 2003 and March 2015. Read More

A A Case Rep 2017 Mar;8(6):139-141

From the *Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada; and †Department of Otolaryngology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.

Airway management in trauma is a crucial skill, because patients are at risk of aspiration, hypoxia, and hypoventilation, all of which may be fatal in the setting of increased intracranial pressure. The King Laryngeal Tube reusable supraglottic airway (King Systems, Noblesville, IN) allows for temporary management of a difficult airway but poses a challenge when an attempt is made to exchange the device for an endotracheal tube, often managed by emergency tracheostomy. We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube. Read More

J Anaesthesiol Clin Pharmacol 2016 Oct-Dec;32(4):515-518

Department of Anaesthesiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India.

Background And Aims: Direct laryngoscopy is hazardous in patients with cervical posterior intervertebral disc prolapse (PIVD) as it may worsen the existing cord compression. To achieve smooth intubation, many adjuncts such as fiberoptic bronchoscope (FOB), video laryngoscopes, lighted stylets, and intubating laryngeal mask airways (ILMAs) are available. However, there is a paucity of literature comparing ILMA with fiberoptic intubation in patients with PIVD. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2016 Nov 24;51(11-12):656-663. Epub 2016 Nov 24.

Department of Anesthesia & Peri-operative Medicine, Western University, London, Ontario, Canada.

Introduction: Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Read More

Acta Anaesthesiol Scand 2017 Jan 3;61(1):23-30. Epub 2016 Nov 3.

Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.

Introduction: supraglottic airway devices remain, despite advances in video laryngoscopy, important tools in the management of unexpected difficult airways. Intubation through a functioning supraglottic airway device with the aid of a fiberoptic bronchoscope is a well-known technique usually performed in apnoea. With a simple modification, the patient can be ventilated during this procedure. Read More

Rev Bras Anestesiol 2018 Jan - Feb;68(1):87-90. Epub 2016 Sep 28.

Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile. Electronic address:

Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al.

Case Report: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Read More

Middle East J Anaesthesiol 2016 Oct;23(6):665-73

Ludwig’s angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, securing the airway, and formal surgical drainage of the infection. Awake fiberoptic intubation under topical anesthesia may be the preferred method to secure the airway. Read More

Am J Emerg Med 2016 Dec 27;34(12):2408-2410. Epub 2016 Aug 27.

Department of Emergency Medicine, Cook County Hospital, 1900 W Polk St, 10th Floor, 60612, Chicago, IL.

Introduction: Patients with severe pulmonary hemorrhage due to unilateral trauma or a bleeding cancer often present to the emergency department in acute respiratory distress. Although it is generally recommended to perform single lung intubation, most emergency department providers do not have access to or are not familiar with double-lumen endotracheal tubes, and blind insertion of an endotracheal tube to maximum depth does not ensure that the proper (nonhemorrhagic) lung is ventilated. Therefore, single lung intubation may be significantly delayed in these patients. Read More

Anesthesiology 2016 10;125(4):656-66

From the Department of Anesthesiology, Oregon Health & Science University, Portland, Oregon (M.F.A., A.M.B.); Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (D.W.H., A.S., T.T., J. Ragheb, S.K.); Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (A.W.W.); Department of Anesthesiology, University of Colorado, Aurora, Colorado (L.J.); Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (D.A.B.); Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont (W.C.P.); Department of Anesthesiology, Washington University, St. Louis, Missouri (J. Rao); Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee (J.L.E.); Department of Anesthesiology, University of Virginia, Charlottesville, Virginia (D.A.C.); and Department of Anesthesiology, University of Utah, Salt Lake City, Utah (P.B.).

Background: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Read More

Acta Clin Croat 2016 Mar;55 Suppl 1:108-11

Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. Read More

Acta Clin Croat 2016 Mar;55 Suppl 1:51-4

The primary goal of pediatric airway management is to ensure oxygenation and ventilation. Routine airway management in healthy pediatric patients is normally easy in experienced hands. Really difficult pediatric airway is rare and usually is associated with anatomically and physiologically important findings such as congenital abnormalities and syndromes, trauma, infection, swelling and burns. Read More

J Clin Anesth 2016 Jun 22;31:46-52. Epub 2016 Mar 22.

Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Study Objective: To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts. Read More

Paediatr Anaesth 2016 Apr 25;26(4):429-37. Epub 2016 Jan 25.

Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.

Background: Bardet-Biedl syndrome (BBS) is a rare genetic condition with manifestations that can impact anesthetic and perioperative care. There is a void of literature describing the perioperative anesthetic management in this complex patient population.

Objectives: The purpose of this retrospective series was to describe the perioperative care of patients diagnosed with BBS at a large academic tertiary referral center with experience in caring for these patients. Read More

Rev Esp Anestesiol Reanim 2016 Apr 8;63(4):189-91. Epub 2016 Jan 8.

Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Head of the Anaesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, Spain. Electronic address:

AANA J 2015 Dec;83(6):389-97

Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports. Read More

Int J Pediatr Otorhinolaryngol 2015 Dec 23;79(12):2196-9. Epub 2015 Oct 23.

Department of Pediatrics, Temple University School of Medicine, United States; Department of Medicine, Temple University School of Medicine, United States; Department of Physiology, Temple University School of Medicine, United States; Department of Thoracic Medicine and Surgery, Temple University School of Medicine, United States; The Centers for Inflammation, Translation and Clinical Lung Research, Temple University School of Medicine, United States; CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Temple University School of Medicine, United States.

Objectives: Medical students and residents in training have limited opportunities to develop pediatric endoscopy skills and would benefit from a realistic simulation model. We sought to develop such a model for flexible endoscopy using fresh head and neck tissue from young sheep.

Methods: Tissue was collected from pre-pubescent sheep (n=5; mean age: 4 months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. Read More

Paediatr Anaesth 2015 Aug;25(8):863-864

Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India.

Anesthesiol Clin 2015 Jun;33(2):241-55

Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, 3EN-421, Toronto, Ontario M5G 2C4, Canada. Electronic address:

After a prolonged period of stagnation, many new airway devices have entered the clinical arena. Along with these, practice guidelines based primarily on expert opinion have been endorsed by specialty societies. These guidelines encourage a rational progression in strategies rather than persistent ineffective efforts. Read More

Paediatr Anaesth 2015 Aug 27;25(8):801-806. Epub 2015 Apr 27.

Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.

Background: The GlideScope Cobalt Video laryngoscope is being used more often in children with challenging laryngoscopy. There are, however, no pediatric trials comparing it to flexible fiberoptic bronchoscopy, the current accepted gold standard. This preliminary manikin study compares the first-attempt intubation success of the GlideScope Cobalt video laryngoscope to the flexible fiberoptic bronchoscope when performed by attending pediatric anesthesiologists at two major pediatric centers. Read More

Burns 2015 Dec 11;41(8):1627-1635. Epub 2015 Apr 11.

Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India. Electronic address:

Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. Read More

Masui 2014 Nov;63(11):1284-6

A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. Read More

J Chin Med Assoc 2014 Sep 20;77(9):496-9. Epub 2014 Aug 20.

Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address:

We report a case of large thyroid carcinoma with tracheal and esophageal invasion who presented with preoperative stridor scheduled for total thyroidectomy and segmental tracheal resection. Careful and comprehensive preoperative anesthetic planning was done. Extracorporeal circulation membrane oxygenation (ECMO) was set up and running prior to induction under local anesthesia, due to an increased international normalized ratio (INR) and fear of bleeding in the airway. Read More

Middle East J Anaesthesiol 2014 Feb;22(4):385-92

Background: Awake fiberoptic intubation is the gold standard for management of predicted difficult intubation. The purpose of this study was to test whether Glide Scope video laryngoscopy (GVL) will provide significant advantages over fiberoptic bronchoscopy (FOB) for awake intubation in morbidly obese patients with predicted difficult intubation. We therefore tested the hypothesis that intubation using GVL is faster than intubation with FOB. Read More

Paediatr Anaesth 2014 May 13;24(5):531-3. Epub 2014 Jan 13.

Department of Anaesthesiology and intensive care, All India Institute of Medical Sciences, New Delhi, India.

An eleven-year-old child presented with a history of gradually increasing left side neck swelling and snoring for the last 6 years. He was initially scheduled for biopsy and on a second occasion for transcervical excision of left parapharyngeal mass under general anesthesia. Examination showed a left lateral pharyngeal and tonsillar mass compressing the oropharyngeal airway. Read More

Hawaii J Med Public Health 2013 Oct;72(10):346-9

John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).

Tracheal Intubation is an important yet difficult skill to learn with many possible methods and techniques. Direct laryngoscopy is the standard method of tracheal intubation, but several instruments have been shown to be less difficult and have better performance characteristics than the traditional direct method. We compared 4 different intubation methods performed by novice intubators on manikins: conventional direct laryngoscopy, video laryngoscopy, Airtraq® laryngoscopy, and fiberoptic laryngoscopy. Read More

Otolaryngol Head Neck Surg 2013 Dec 3;149(6):840-4. Epub 2013 Oct 3.

Departments of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Objectives: Patients with acromegaly present unique challenges to cranial base surgery and anesthesia teams in the perioperative period, especially with regard to airway management. Abnormal airway anatomy may result from soft tissue hypertrophy and bony alterations. Additional perioperative challenges relate to the management of medical comorbidities. Read More

J Clin Monit Comput 2014 Apr 18;28(2):169-72. Epub 2013 Sep 18.

Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Gaziantep, 27310, Sahinbey, Gaziantep, Turkey,

Airway management in patients with ankylosing spondylitis (AS) is a challenging problem for anesthesiologists. The GlideScope video laryngoscope (GVL) is designed to assist tracheal intubation for patients with a difficult airway. The aim of the study was to report the successful intubation by GVL of four AS patients, and to discuss the use of GVL for tracheal intubation in patients with AS by performing a review of the literature. Read More

Minerva Anestesiol 2013 Nov 1;79(11):1259-63. Epub 2013 Jul 1.

Thoracic Surgery Unit, Department of Surgical Science, Ospedale S. Maria, University of Perugia, Perugia, Italy -

Background: Cricopharyngeal foreign bodies (FBs) impaction in adults is a common clinical problem; without treatment, the sequelae may be lethal due to local and/or mediastinal infection. When direct laryngoscopy and flexible fiberoptic endoscopy are ineffective, rigid endoscopy is the method of choice requiring general anesthesia. The new video laryngoscopes represent a great advancement in the assessment of the laryngeal inlet. Read More

Middle East J Anaesthesiol 2012 Oct;21(6):785-91

Anesthesiology Department, American University of Beirut Medical Center, Beirut, Lebanon.

Management of difficult tracheal intubation has been facilitated by different techniques which include the use of stylets, introducers, intubating laryngeal mask airway, as well as by the development of special laryngoscope blades and fiberoptic laryngoscopes. The most recent advances for facilitation of difficult tracheal intubation is the introduction of the video-assisted laryngoscopes. The management of difficult tracheal intubation by video-assisted laryngoscopy can be further facilitated by using suspension laryngoscopy which frees the hands of the anesthesiologist to handle the insertion of the endotracheal tube with the aid of an endotracheal tube introducer, and a curved pipe stylet, under an umbrella of pharyngeal oxygen insufflation. Read More

Anesthesiol Clin 2013 Mar 3;31(1):157-66. Epub 2012 Nov 3.

Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239, USA.

Patients with trauma may have airways that are difficult to manage. Patients with blunt trauma are at increased risk of unrecognized cervical spine injury, especially patients with head trauma. Manual in-line stabilization reduces cervical motion and should be applied whenever a cervical collar is removed. Read More

Anesthesiology 2013 Feb;118(2):462-3

Acta Clin Croat 2012 Sep;51(3):493-8

Department of Anesthesiology, Sv. Katarina Special Hospital for Orthopedic Surgery, Neurology, Physical Medicine and Rehabilitation, Bracak, Croatia.

Goiter or thyromegaly is one of the most common causes of mid tracheal obstruction (external compression or stenosis), which may be associated with difficult larynx visualization and/or difficult airway management, depending on the goiter size, type and ingrowth into the surrounding tissue. Iodine deficiency disorders are still one of the most common causes of goiter in the population of the African continent. These patients with goiter generally present for medical examination at an advanced stage of the disease. Read More

AANA J 2012 Oct;80(5):347-53

VA Medical Center, Iowa City, Iowa, USA.

Difficult airway management remains central to anesthesia practice. Video laryngoscopes have been an adjunct to airway management since the early 2000s. They have been shown to improve visualization of the glottic opening and have become a useful aid in managing difficult airways. Read More

Anesthesiology 2012 Jun;116(6):1210-6

Department of Anesthesiology, Copenhagen University Hospital, Hillerød, Denmark.

Background: Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI. Read More

J Clin Anesth 2011 Dec;23(8):632-5

Department of Anesthesiology, Harper University Hospital, Detroit Medical Center, Detroit, MI 48201, USA.

Study Objective: To calculate the costs per intubation of reusable fiberoptic scopes versus single-use intubation scopes.

Design: Open-label retrospective study.

Setting: University-affiliated hospital. Read More

Acta Anaesthesiol Belg 2010 ;61(2):67-70

Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven, The Netherlands.

Acute epiglottitis is a potentially life-threatening infection of the supraglottic structures, which can lead to sudden, fatal airway obstruction. Different techniques have been described to facilitate tracheal intubation in acute epiglottitis. We describe the successful intubation, with the help of the videolaryngoscope, of a 60-year-old female with acute epiglottitis. Read More

J Clin Anesth 2010 Dec;22(8):642-7

Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, GA 30912, USA.

The video RIFL (rigid flexible laryngoscope) is an airway management adjunct designed to facilitate endotracheal intubation. It is a novel stylet-based laryngoscope that incorporates a complementary metal oxide sensor distal chip imaging system and real-time articulation tip. The device combines features desired in fiberoptic bronchoscopy as well as in video laryngoscopy. Read More

Paediatr Anaesth 2009 Nov 25;19(11):1102-7. Epub 2009 Aug 25.

Department of Pediatric Anesthesia and Pediatric Critical Care, IWK Health Centre, Halifax, NS, Canada.

Introduction: Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15 degrees . The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. Read More

Pediatr Emerg Care 2009 Jul;25(7):473-9; quiz 480-2

Division of Critical Care, British Columbia Children's Hospital, Vancouver, British Columbia, Canada V6H 3V4.

Endotracheal intubation in the pediatric emergency department can be challenging. Direct laryngoscopy is the primary intubation technique used in pediatric emergency intubations. However, cases arise where abnormalities of the upper airway prevent a direct view of the laryngeal opening. Read More

Curr Opin Anaesthesiol 2008 Dec;21(6):750-8

Department of Anesthesiology, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania 17033, USA.

Purpose Of Review: Recent advances in fiberoptic systems and video technology have resulted in the development of new intubation devices and techniques. A defining characteristic of rigid fiberoptic and videolaryngoscopic techniques is that glottic opening is viewed indirectly in place of direct line-of-sight. Various issues common to all instruments in this group are highlighted, and a few recently released tools are described. Read More

Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2007 Feb;29(1):117-23

Department of Anesthesiology, Plastic Surgery Hospital, CAMS and PUMC, Beijing 100041, China.

Objective: To compare the hemodynamic responses to nasotracheal intubation with Glide Scope video-laryngoscope (GSVL), Macintosh direct laryngoscope (MDLS), and fiberoptic bronchoscope (FOB).

Methods: Sixty patients, with American Society of Anesthesiologists (ASA) physical status I - II, aged 18- 50 years, and scheduled for elective plastic surgery under general anesthesia requiring nasotracheal intubation, were randomly allocated equally to GSVL group, MDLS group, and FOB group. After the routine anesthesia induction, nasotracheal intubation was performed with the GSVL, MDLS, and FOB, respectively. Read More

Arch Otolaryngol Head Neck Surg 2007 Mar;133(3):266-9

Department of Anesthesia, Penn State College of Medicine, Hershey, PA, USA.

Objective: To study the feasibility of using laryngeal mask anesthesia (LMA) with bronchoscopic evaluation of recurrent laryngeal nerve (RLN) integrity when stimulated.

Design: Single-institution prospective case series.

Setting: A single, mid-Atlantic region academic medical center. Read More

Ann Emerg Med 2007 Jan 18;49(1):81-3. Epub 2006 May 18.

Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Numerous rigid indirect fiberoptic and video-based airway tools have been developed as potential alternatives to direct laryngoscopy for intubation. Compared with flexible fiberoptic bronchoscopes, these devices are less expensive and may be easier to use. The role of these rigid instruments in managing the difficult airway in the emergency department is yet to be defined. Read More