Manoeuvres used to clear the airway during fibreoptic intubation

Fibreoptic orotracheal endoscopy under general anaesthesia may be more difficult to perform if the upper airway cannot be fully cleared. We have studied the effectiveness of jaw thrust, lingual traction and the application of both manoeuvres simultaneously, in opening up the orolaryngeal airspace in 30 ASA group 1 or 2 patients aged between 16 and 70 yr undergoing elective general surgery requiring orotracheal intubation. Airway clearance was assessed fibreoptically at soft palate level by observing whether or not the uvula or soft palate was apposed to the base of the tongue, and at epiglottic level by observing whether or not the epiglottis was apposed to the posterior pharyngeal wall. Lingual traction with Duval's forceps cleared the tongue away from the uvula and soft palate significantly more times than did jaw thrust (P<0.05). Jaw thrust cleared the epiglottis away from the posterior pharyngeal wall more frequently than did lingual traction (P=0.052). Applying both jaw thrust and lingual traction simultaneously cleared the airway at both soft palate and epiglottic level in every patient. When used alone, jaw thrust and lingual traction fail to produce full airway clearance in a significant number of patients. Combined jaw thrust and lingual traction clears the airway more effectively but requires two assistants.