A quick introduction and overview of the the TotalTrack Video Laryngeal Mask.
A video example of performing a straightforward intubation using the AirTraq optical laryngoscope, here coupled with the WiFi-enabled camera unit to allow image capture. Note the optimal positioning (“Rule of 3”):
This intubation is using a reinforced (“armored”) endotracheal tube, which is sometimes more difficult than a standard ETT, as it is a little floppier. The AirTraq makes it simple in this instance. The reinforced ETT was used to facilitate patient positioning for a neurosurgical case.
Over the past two weeks, I have been involved in three cases where all means of laryngoscopic intubation failed – including multiple different blades, introducers and highly skilled hands – and the airway could only be intubated with a flexible fibreoptic ‘scope. These three cases illustrate the type of pathology that can make even video laryngoscopy (VL) difficult or impossible:
In an article on the Airway E-Learning site, Dr Matthew Wiles details why he thinks fibreoptic intubation (FOI) is becoming a rare beast, and why we should work hard to maintain excellence in this important skill.
Despite being a huge fan and daily user of VLs, I am completely in agreement with his sentiments.
The well-known thoracic anaesthesia guru, Prof Jay Brodsky, has written a succinct and simple overview of the use of fibreoptic bronchoscopy (FOB) in thoracic anaestheisa, which is equally applicable to the modern flexible video endoscopes. If you are looking for a brief primer (including the appropriate use for placement of bronchial blockers and double-lumen ETTs), read the article on the Airway E-Learning site here.
Importantly, he elucidates the reasons for becoming proficient in the clinical placement and confirmation of DLTs without the use of a FOB, which is of particular relevance here in the developing world.
A quick video aimed at introducing our clinicians to a new piece of equipment, but potentially a useful overview of this type of device to anyone who may make use of portable flexible ‘scopes.
…to come and have great fun on our courses at UCT. This from the hands-on airway endoscopy afternoon run recently for the Department of Anaesthesia’s own staff:
Two and a half minutes to quickly bring you up to speed on the anatomy of a flexible intubating endoscope:
This month’s edition of Anesthesiology News features a worthwhile piece from Prof John Doyle, in which he poses 7 questions on the current state of airway management to 6 airway experts from around the world (Abdelmalak, Cooper, Frova, Rosenblatt, Spiegel and Doyle himself), and collates their responses into a dialogue. Definitely worth reading to determine what some (certainly not all) of the biggest names in the world are thinking on:
You can read the article on the Anesthesiology News site by clicking here or the image above, or download the PDF version here.
For what it is worth, here are my own answers, distilled into one-liners. I’m very willing to enter into discussions about them!
There are a lot of excellent (and complementary) views expressed in the article, which are worth reading. Check it out!
Rigid endoscopes are very valuable tools for intubation in certain difficult scenarios, but are not commonly used in most centres. The techniques and learning curve differ significantly from normal direct laryngoscopy, requiring independent practice to become proficient. Pictured here are (left to right) a rigid bronchoscope, Bonfils, Levitan and Shikani optical stylets (rigid intubating endoscopes).
This is the set-up for basic training on an UCT Anaesthesia Airways course. Which of these devices have you used? Do you have tricks or comments to share?