New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway

New Maneuver to Facilitate Fiberoptic Intubation for Difficult Airway: A Prospective, Randomized Study

We propose the additional technique of lingual traction or "tongue pulling" in conjunction with use of the flexible fiberoptic bronchoscope for facilitating successful first attempts at and decreasing time to intubation of the difficult airway and rescuing otherwise failed intubation attempts. Induction of general anesthesia causes relaxation and approximation of the soft palate, base of the tongue, epiglottis, and posterior pharyngeal wall, creating unfavorable anatomic changes in the pharynx for successful intubation. The use of lingual traction can assist in diminishing these problems by clearing the tongue away from the soft palate and uvula and lifting the epiglottis from the posterior pharyngeal wall, especially in the unanticipated difficult airway patient.

Inclusion Criteria:

• > 18 years old
• With ASA (American Society of Anesthesiologists) physical status I-III
• With anticipated difficult airway
• Scheduled for elective surgery requiring orotracheal intubation (populations such as elective hip and knee arthroplasty patients)
• Provide written consent

Exclusion Criteria:

• With (American Society of Anesthesiologists) ASA physical status IV
• Pregnant
• Require rapid-sequence induction
• Require a non-standard tracheal tub
• Unable to provide written consent
• At risk for pulmonary aspiration of gastric content