ENDOTRACHEAL INTUBATION USING A FIBEROPTIC LARYNGOSCOPE

Experience with a new type of laryngoscope (Bullard(R)) is reported. It weighs 1,200 kg, and has fiberoptic fibers both for lighting and viewing. Angle of vision is about 55-degrees. Endotracheal intubation with this device requires a semi-rigid stylet to bend the tracheal tube at 90-degrees just above its cuff, so as to reproduce the curvature of the laryngoscope blade. Intubation is carried out in five steps: 1) introducing the laryngoscope blade, and visualising the vocal cords through its lens; 2) introducing the tube with its stylet, just above the laryngoscope blade; 3) placing the tube between the vocal cords under fiberoptic vision; 4) adjusting tube position in the trachea, the stylet still in place; 5) removing both stylet and laryngoscope. The use of this apparatus in an obese patient with reduced mobility of the cervical spine, who was ranked 4 on the Mallampati scale, is reported. The Bullard(R) laryngoscope enabled easy tracheal intubation (duration 1 min 30 s), whereas direct laryngoscopy and the use of a Huffman prism were unsuccessful. The fiberoptic laryngoscope may be of help in case of difficult intubation.