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01-04-2015 | Original Article

Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial

Authors: Yiu-Hei Ching, Rachel A. Karlnoski, Henian Chen, Enrico M. Camporesi, Vimal V. Shah, Tapan A. Padhya, Devanand Mangar

Published in: Journal of Anesthesia | Issue 2/2015

Abstract

Purpose

Flexible fiber-optic bronchoscope-guided orotracheal intubation is a valuable technique with demonstrated benefits in the management of difficult airways. Despite its popularity with anesthesia providers, the technique is not fail-safe and airway-related complications secondary to failed intubation attempts remain an important problem. We sought to determine the effect of incorporating lingual traction on the success rate of fiber-optic bronchoscope-guided intubation in patients with anticipated difficult airways.

Methods

In this prospective, randomized, cohort study, we enrolled 91 adult patients with anticipated difficult airways scheduled for elective surgery to undergo fiber-optic bronchoscope-guided orotracheal intubation alone or with lingual traction by an individual anesthesiologist after induction of general anesthesia and neuromuscular blockade. A total of 78 patients were randomized: 39 patients to the fiber-optic bronchoscope-guided intubation with lingual traction group and 39 patients to the fiber-optic bronchoscope-guided intubation alone group. The primary endpoint was the rate of successful first attempt intubations. The secondary outcome was sore throat grade on post-operative day 1.

Results

Fiber-optic intubation with lingual traction compared to fiber-optic intubation alone resulted in a higher success rate (92.3 vs. 74.4 %, χ ² = 4.523, p = 0.033) and greater odds for successful first attempt intubation (OR 4.138, 95 % CI 1.041–16.444, p = 0.044). Sore throat severity on post-operative day 1 was not significantly different but trended towards worsening grades with lingual traction.

Conclusions

In this study, lingual traction was shown to be a valuable maneuver for facilitating fiber-optic bronchoscope-guided intubation in the management of patients with anticipated difficult airways.

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Title: Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial
Authors: Yiu-Hei Ching
Rachel A. Karlnoski
Henian Chen
Enrico M. Camporesi
Vimal V. Shah
Tapan A. Padhya
Devanand Mangar
Publication date: 01-04-2015
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 2/2015
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-014-1920-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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