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Evaluation of a New
Technique for Macintosh Oral Intubation
Mohamed Hassan Ahmed
Soliman
Anesthesia Department, Faculty of Medicine, Ain Shams University,
Egypt
Tanta Med. Sc. J 2008; 3(2):118-126
Article type: Original
article
Background/Aim: Laryngoscopic view grades, according to modified
Cromack and Lehane (C&L), I and possibly IIA denote easy while IIB,
III and IV difficult intubation. Over the last three years, using
Macintosh blade (MCB) for oral intubation in adults, the author
found that by manipulating the proximal end of the tube with your
fingers, the distal end moves facilitating intubation. The aim of
this study is to evaluate a new technique invented by the author,
which is called the manual tube control (MTC) technique, during MCB
oral intubation in adults. The technique depends mainly on control
of the proximal end of the endotracheal tube (ETT) between the
thumb, the index and the middle fingers of the intubator's right
hand and manipulating according to the laryngoscopic view. Material
& Methods: In a prospective single blind randomized clinical study,
oral tracheal intubation using MCB size 4 was evaluated in 100 adult
patients scheduled for elective surgery under general anesthesia,
according to the tube holding technique. Inclusion criteria are
American Society of Anesthesiologists (ASA) I adult patients who
showed Mallampati III and IV during preoperative airway assessment
and then initial laryngoscopic view (C&L) III and IV (without
external laryngeal pressure) after general anesthesia. The study
excluded cases that showed limited mouth opening (less than 2
fingers), problems related to mouth, teeth, pharynx, cervical spine,
gastric reflux, sleep apnea and cases of pregnancy or bad anesthetic
history. 7 cm height foam pillows were put under the patient's head,
neck and shoulders and the initial laryngoscopic view was improved
with external laryngeal pressure. The patients were divided into two
groups according to the method of ETT holding during intubation:
group U: 50 patients where the ETT was held in the usual way, and
group M: 50 patients where the MTC technique was used. Patients who
could not be intubated after two trials in the same group would be
shifted to the other group. If the patients still could not be
intubated after two trials in the other group, LMA Fastrach™ (intubating
laryngeal mask airway) would be used. Results: Both groups were
comparable as regards demographic data, operative procedures and
airway variables P>0.05. In group U, it was easy to intubate all
cases of view I (C&L) in the first trial and only 4 cases (57%) of
group IIA in the second trial while all other cases were shifted to
group M where they were successfully intubated. All group M cases
were successfully intubated in the same group. The total number of
successful intubations using the group M technique was more than
that using the group U technique with a highly significant
difference P < 0.001. LMA Fastrach™ was not needed in any case and
no complications were recorded. Conclusion: The MTC technique is an
efficient way for adult oral tracheal intubation using MCB size 4
even in cases of difficult laryngoscopic views.
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