Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-26T07:16:56.923Z Has data issue: false hasContentIssue false
  • English
  • Français

Does left molar approach to laryngoscopy make difficult intubation easier than the conventional midline approach?

Published online by Cambridge University Press:  01 August 2008

N. Bozdogan ,
M. Sener ,
A. Bilen ,
A. Turkoz ,
A. Donmez  and
G. Arslan
N. Bozdogan*
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
M. Sener
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
A. Bilen
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
A. Turkoz
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
A. Donmez
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
G. Arslan
Affiliation:
Baskent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey
*
Correspondence to: Nesrin Bozdogan, Anesteziyoloji ve Reanimasyon AD, Baskent Universitesi Adana Seyhan Hastanesi, Baraj yolu 1. durak no: 37, 01140 Seyhan/Adana, Turkey. E-mail: nesrinbozdogan@yahoo.com; Tel: +90 322 4586868, Ext. 1226; Fax: +90 322 4592622
Get access

Summary

Background and objective

It has been reported that the left molar approach of laryngoscopy can make difficult intubation easier. The aim of this study was to investigate whether left molar approach to laryngoscopy provided a better laryngeal view in cases of unexpected difficult intubation.

Methods

Following the approval of local Ethics Committee and written informed consent from the patients, out of 1386 patients who underwent general anaesthesia for surgery, 20 patients who could be ventilated by face mask but could not be intubated with conventional midline approach on the first attempt were included in the study. Those 20 patients, who had Grade III-IV laryngeal views on laryngoscopy by conventional midline approach, were subjected to left molar laryngoscopy, and their laryngeal views were evaluated. The external laryngeal compression was routinely used to improve the laryngeal view. When endotracheal intubation failed by left molar laryngoscopy, we performed the conventional midline approach again. All data were recorded.

Results

Of the 20 patients studied, 18 had a Grade III laryngeal view and two had a Grade IV laryngeal view. Eighteen of them had a better laryngeal view with left molar laryngoscopy. Eleven of the 20 patients underwent successful intubation with the left molar laryngoscopy, which provided a significantly better laryngeal view and success rate of tracheal intubation than did the conventional midline approach (P < 0.01 and P < 0.01, respectively).

Conclusions

Left molar laryngoscopy can make unexpected difficult intubation easier and should be attempted in cases of difficult intubation.

Keywords

INTUBATION INTRATRACHEAL, techniqueLARYNGOSCOPES, MacintoshLARYNX
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 681 - 684
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Schmitt, HJ, Kirmse, M, Radespiel-Troger, M. Ratio of patient’s height to thyromental distance improves prediction of difficult laryngoscopy. Anaesth Intensive Care 2002; 30: 763–765.CrossRefGoogle ScholarPubMed
2.Tse, JC, Rimm, EB, Hussain, A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesth Analg 1995; 81: 254–258.Google ScholarPubMed
3.Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.CrossRefGoogle ScholarPubMed
4.Schmitt, HJ, Mang, H. Head and neck elevation beyond the sniffing position improves laryngeal view in cases of difficult direct laryngoscopy. J Clin Anesth 2002; 14: 335–338.CrossRefGoogle ScholarPubMed
5.Tamura, M, Ishikawa, T, Kato, R, Isono, S, Nishino, T. Mandibular advancement improves the laryngeal view during direct laryngoscopy performed by inexperienced physicians. Anesthesiology 2004; 100: 598–601.CrossRefGoogle ScholarPubMed
6.Benumof, JL, Cooper, SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth 1996; 8: 136–140.CrossRefGoogle ScholarPubMed
7.Henderson, JJ. The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation. Anaesthesia 1997; 52: 552–560.CrossRefGoogle ScholarPubMed
8.Mallampati, SR, Gatt, SP, Gugino, LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–434.CrossRefGoogle ScholarPubMed
9.Wilson, ME, Spiegelhalter, D, Robertson, JA, Lesser, P. Predicting difficult intubation. Br J Anaesth 1988; 61: 211–216.CrossRefGoogle ScholarPubMed
10.Yamamoto, K, Tsubokawa, T, Ohmura, S, Itoh, H, Kobayashi, T. Left-molar approach improves the laryngeal view in patients with difficult laryngoscopy. Anesthesiology 2000; 92: 70–74.CrossRefGoogle ScholarPubMed
11.Farley, C, Bowler, I, Stacey, M. The left molar approach assisting fibreoptic intubation. Anaesthesia 2002; 57: 1031–1033.CrossRefGoogle ScholarPubMed
12.Mentzelopoulos, SD, Armaganidis, A, Niokou, D et al. MRI of the upper airway and McCoy-balloon laryngoscopy with left molar approach in a patient with arthrogryposis multiplex congenita and previous unsuccessful endotracheal intubation. Anesth Analg 2004; 99: 1879–1880.CrossRefGoogle Scholar
13.Sato, N, Shingu, K. Another reason to choose the left molar approach of laryngoscopy: to spare the incisor teeth. Anesthesiology 2002; 96: 1279.CrossRefGoogle ScholarPubMed
14.Asai, T. The view of the glottis at laryngoscopy after unexpectedly difficult placement of the laryngeal mask. Anaesthesia 1996; 51: 1063–1065.CrossRefGoogle ScholarPubMed
15.Mulcahy, AJ, Yentis, SM. Management of the unexpected difficult airway. Anaesthesia 2005; 60: 1147–1148.CrossRefGoogle ScholarPubMed
16.American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269–1277. Erratum in: Anesthesiology 2004; 101: 565.CrossRefGoogle Scholar
17.Koyama, J, Aoyama, T, Kusano, Y et al. Description and first clinical application of Airway Scope for tracheal intubation. J Neurosurg Anesthesiol 2006; 18: 247–250.CrossRefGoogle ScholarPubMed