|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 98-99
Awake intubation with i-scope videolaryngoscope in a case of limited mouth opening
Sarfaraz Ahmad1, Shagufta Naaz1, Rajnish Kumar1, Neeraj Kumar2
1 Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
|Date of Submission||22-May-2022|
|Date of Acceptance||14-Jul-2022|
|Date of Web Publication||08-Aug-2022|
Dr. Sarfaraz Ahmad
Department of Anaesthesiology and Critical Care Medicine, Room No 603, B Block, OT Complex, All India Institute of Medical Sciences, Phulwari Sharif, Patna - 801 507, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahmad S, Naaz S, Kumar R, Kumar N. Awake intubation with i-scope videolaryngoscope in a case of limited mouth opening. Airway 2022;5:98-9
|How to cite this URL:|
Ahmad S, Naaz S, Kumar R, Kumar N. Awake intubation with i-scope videolaryngoscope in a case of limited mouth opening. Airway [serial online] 2022 [cited 2022 Sep 28];5:98-9. Available from: https://www.arwy.org/text.asp?2022/5/2/98/353547
Securing the airway in a patient with limited mouth opening remains a challenge for the anaesthesiologist. In such cases, awake ﬁbreoptic bronchoscopic intubation is considered the gold standard. However, the technique is time-consuming and requires expertise. In addition, the fibreoptic bronchoscope is expensive and is not easily available at all centres.
A 45-year-old male weighing 60 kg belonging to the American Society of Anesthesiologists Physical Status I presented to the Emergency Department of our hospital following a road traffic accident. He had sustained blunt trauma to the right eye and was scheduled for enucleation surgery. Mobility at the temporomandibular joint was restricted since birth, resulting in a restricted mouth opening of only 1.2 cm [Figure 1]a. On arrival in the operation theatre, five-electrode electrocardiogram monitoring Lead II and V5 and noninvasive blood pressure and pulse oximetry monitoring were established. Topical anaesthesia of the airway was achieved with nebulisation of 4 mL of 4% lignocaine over 5 min, spraying of 10% lignocaine onto the dorsum of the protruded tongue during mouth breathing and bilateral superior laryngeal nerve block (2 mL of 2% lignocaine on each side). Injection dexmedetomidine 0.75 μg/kg was given over 10 min before the procedure for blunting stress response to laryngoscopy and intubation.
|Figure 1: (a) Patient with limited mouth opening. (b) The i-Scope videolaryngoscope with an endotracheal tube. (c) Visualising the vocal cords using the i-Scope videolaryngoscope|
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As a working fibreoptic bronchoscope was not available at our centre, we used an i-Scope videolaryngoscope. Tracheostomy was planned as a backup in an emergency. The stylet of the i-Scope videolaryngoscope loaded with an 8.0 mm internal diameter endotracheal tube (ETT) [Figure 1]b was introduced along the right angle of the mouth. After that, the i-Scope was rotated anticlockwise through 90° with the stylet of the i-Scope resting over the centre of the tongue. The vallecula and the vocal cords were visualised on the screen [Figure 1]c. The ETT was slid down the stylet of the videolaryngoscope and its position was confirmed with capnography and auscultation of the chest. General anaesthesia was induced with injection propofol 2 mg/kg, fentanyl 2 μg/kg and atracurium 0.5 mg/kg. The intraoperative period was uneventful. The patient was extubated successfully after 2 h of surgery when the patient was fully awake.
Videolaryngoscopes are emerging as new airway gadgets and the most innovative advancement in recent day clinical practice reported for use during awake intubation. These devices provide many advantages such as intubation in patients with impaired neck movements, easier learning curve, improved portability and low cost. The Bonfils intubation fibrescope is almost similar to the i-Scope and is found to be a reliable, atraumatic and well-tolerated instrument to secure a safe airway in patients with a limited mouth opening. A comparative study also concluded that the Video Stylet takes lesser time for intubation with a higher success rate as compared to the fibreoptic bronchoscope. The i-Scope videolaryngoscope is the latest device available in this category and provides a perfect view using video and digital technology and needs very limited mouth opening. The device is inexpensive and portable. It consists of a two-piece design. The monitor is attached to a preformed stylet incorporated with a camera at the tip. To the best of our knowledge, this device has not been used in patients with restricted mouth opening for awake intubation.
In conclusion, the i-Scope videolaryngoscope can be a good option for awake intubation in patients with limited mouth opening and may provide a suitable alternative to fibreoptic intubation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Messeter KH, Pettersson KI. Endotracheal intubation with the fibre-optic bronchoscope. Anaesthesia 1980;35:294-8.
Tvede MF, Kristensen MS, Nyhus-Andreasen M. A cost analysis of reusable and disposable flexible optical scopes for intubation. Acta Anaesthesiol Scand 2012;56:577-84.
Gaszynska E, Gaszynski T. The King Vision™ video laryngoscope for awake intubation: Series of cases and literature review. Ther Clin Risk Manag 2014;10:475-8.
Shollik NA, Ibrahim SM, Ismael A, Agnoletti V, Piraccini E, Corso RM. Use of the Bonfils Intubation Fiberscope in patients with limited mouth opening. Case Rep Anesthesiol 2012;2012:297306.
Amir SH, Ali QE, Bansal S. A comparative evaluation of Video Stylet and flexible fibre-optic bronchoscope in the performance of intubation in adult patients. Indian J Anaesth 2017;61:321-5.
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