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2014 | 9 | 6 | 768-772

Article title

Awake endotracheal intubation in patients with severely restricted mouth opening- alternative devices to fiberscope: series of cases and literature review


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Awake Fiberoptic Intubation (AFI) is a standard method of airway management in the case of anticipated difficult intubation. It is usually performed with the use of flexible fiberscopes. In this report we have described two methods in which alternative devices to the fiberscope were utilized for awake intubation in patients with severely restricted mouth opening scheduled for craniomaxillofacial surgery: TruView PCD and Levitan FPS. Information about the use of these devices in such conditions has not been previously published in the literature. Some of the possible advantages of these alternative methods for AFI result from the fact that they are easy to use, especially for anesthesiologists who are relatively inexperienced with fiberscope intubation procedures. Additionally, these alternatives are cheaper than fiberscopes and can be used for many AFI procedures.










Physical description


1 - 12 - 2014
16 - 8 - 2014


  • Department of Hygiene and Health Promotion, Medical University of Lodz, Lodz, Poland
  • Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
  • Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland


  • [1] Charlotte V. Rosenstock CV, Thøgersen B, Afshari A, Christensen AL, Eriksen C, Gatke M. Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management. Anesthesiology 2012; 116:1210–1216 http://dx.doi.org/10.1097/ALN.0b013e318254d085[Crossref][WoS]
  • [2] Steven I. Abramson SI, Holmes AA, Hagberg CA. Awake Insertion of the Bonfils Retromolar Intubation Fiberscope™ in Five Patients with Anticipated Difficult Airways. Anesth Analg 2008;106:1215–1217 http://dx.doi.org/10.1213/ane.0b013e318167cc7c[Crossref][WoS]
  • [3] Toll SR, Simon AC, Parraga IC, Marques SL, Gonzalvo SV, Vidal CM. Comparative study of three videolaryngoscopes for nasotracheal intubation with restricted mouth opening: A manikin study: 19AP510. European Journal of Anaesthesiology 2011; 28: 237
  • [4] Raveendra US, Mehandale SG, Shetty SR, Kamath MR. Evaluation of the Truview? EVO2 laryngoscope for nasotracheal intubation. Saudi J Anaesth 2012;6:398–402 http://dx.doi.org/10.4103/1658-354X.105882[Crossref]
  • [5] Xue FS, Liao X, Yuan YJ, Liu JH, Wang Q. Nasotracheal intubation using the Airtraq® optical laryngoscope in patients with a difficult airway. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2011; 58(4): 406–408 http://dx.doi.org/10.1007/s12630-011-9455-0[WoS][Crossref]
  • [6] St Mont G, Biesler I, Pförtner R, Mohr C, Groeben H. Easy and difficult nasal intubation-a randomized comparison of Macintosh vs Airtraq® laryngoscopes. Anaesthesia. 2012;67(2):132–138 http://dx.doi.org/10.1111/j.1365-2044.2011.06943.x[Crossref]
  • [7] Mazères JE, Lefranc A, Cropet C, et al. Evaluation of the Bonfils intubating fiberscope for predicted difficult intubation in awake patients with ear, nose and throat cancer. Eur J Anaesthesiol 2011; 28:646–650 http://dx.doi.org/10.1097/EJA.0b013e3283495b85[Crossref]
  • [8] Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology 1998;88(6):1459–1466 http://dx.doi.org/10.1097/00000542-199806000-00007[Crossref]
  • [9] Liu SS, Brodsky JB and Macario A. Cost Identification Analysis of Anesthesia Fiberscope Use for Tracheal Intubation. J Anesthe Clinic Res 2012, 3:215 doi: 10.4172/2155-6148.1000215 [Crossref]

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