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Planning a procedure in a patient with a known or suspected difficult laryngoscopy involves :
1. Knowing the facility you are working and your familiarity with available equipment and assistants.
2. Nature and urgency of the procedure.
3. Options for anaesthesia.
4. Likelihood of difficult mask-ventilation placing you at additional risk of CICV
4. Being clear on backup plans for failure or primary and secondary options including waking of the patient.

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Apr 02, 2013
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If you've found yourself with a rescue LMA and still needing to intubate, an alternative to a gum elastic bougie is an aintree catheter placed under direct vision over a fibreoptic scope through the LMA. This may help minimise airway trauma associated with blind placement of a bougie. refl.in/3r

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Oct 06, 2012
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A technique for buccal oxygenation to prolong the duration of oxygenated apnoea in patients with difficult laryngoscopy from Dr Andrew Heard. #anzcaasm2012

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Nov 26, 2012
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In the cooperative patient with an expected difficult laryngoscopy and a high aspiration risk, consider performing an awake fiberoptic-intubation. This avoids the potential for emergency ventilation during rapid sequence induction

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Sep 19, 2012
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A two operator technique is possible:
One anesthetist performing laryngoscopy, one anesthetist performing BURP and inserting the endotracheal tube.

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Dec 28, 2012
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In the paediatric patient at risk of aspiration with a difficult laryngoscopy, consider a gas induction in the sitting position, and when deep, lie flat & place cricoid pressure before intubating while spontaneously ventilating.

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Nov 26, 2012
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The levitan intubating-stylet is an option for intubating under direct vision.

This tongue needs to be pulled forward, and this can be done either with a laryngoscope or pull the tongue forward (off the oropharynx) using gauze.

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Oct 06, 2012
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The mcgrath portable-video-laryngoscope-aircraft-medical is an option for the patient with a difficult laryngoscopy.

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Sep 22, 2012
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Avoid GA where practical, but consider the risk of needing to convert to GA intraoperatively where conditions are likely to be suboptimal

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Oct 06, 2012
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If procedure is being performed after hours and patient is going to an ICU with only junior medical staff available, consider sending the patient intubated. They can be extubated during daytime hours when senior cover with better airway skills arrive.

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May 15, 2012
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To assess how well the laryngoscopy grade following intubation correlates with the grade before intubation, this small study of repeat laryngoscopy in 21 paediatric patients ranging in Cormack and Lehaine grade 1 to 4 showed an R of 0.42.
No repeat laryngoscopies diverged more than 1 grade from the first.
#spanza2012 #ref

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Nov 24, 2012
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Good collection of videos using a variety of airway devices including airtraq and aintree catheter
vam.anest.ufl.edu/airwayd...

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Jan 01, 2013
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