Tag Archives: video laryngoscopy

Nairobi Airway Course 2017: Photos

Some photos of the action at the Nairobi Surgical Skills Centre this week. Many thanks to the local faculty from the University of Nairobi and other institutions, the companies that supported use of the facilities and equipment, and the enthusiastic delegates!



Resources and notes from the course are available on the course page here

VLVids: Room for Improvement!

This real-life videolaryngoscopy example (RSI of a patient with a head injury for craniectomy) shows some commom errors, and room for improvement. Three major areas that could be better to spot here:

  1. Less-than-ideal positioning of the VL blade. The tip is too deep (over the epiglottis, rather than in the vallecula), which reduces the available space to manipulate both VL and ETT, the field of vision, and the ability to perceive the approach of the ETT.
  2. Quick suctioning of the secretions/saliva/mucus would reduce the risk of losing the view or the patient aspirating.
  3. An introducer (stylet/bougie) would greatly assist passage of the ETT through the cords.

Is fibreoptic intubation a dying art?

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:

  • A morbidly obese patient in traction with a high spinal injury
  • A patient presenting with late-stage, advanced laryngeal carcinoma with both supra- and infraglottic involvement and masses
  • A child with Pierre-Robin Sequence presenting for mandibular distraction surgery.

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.

Bougie-assisted intubation snagging on arytenoid

This common problem is worst with small bougies, such as in this paediatric example of a child with severe burns and a difficult airway.  The bevel of the ETT allows the tip of the tube to stick out right (laterally) of the bougie and snag on the right arytenoid cartilage.  This can be remedied by withdrawing the ETT slightly (to disengage it from the arytenoid), effecting a one-quarter counter-clockwise rotation of the ETT on the bougie (bringing the bevel and tip of the ETT into a superior midline position snug with the bougie), and then advancing again.