Frequent use of alternative airway techniques makes difficult intubations less and easier

This study is to evaluate how alternative airway techniques work at different scenarios of difficult airways in our department where those techniques are popularized in daily practice.

This is an open and observational study. Ten thousand two hundred and twenty nine adult patients were included in the 7-month period of investigation. When a difficult intubation was recognized, the responsible anesthesiologist would complete a questionnaire that was designed to explore the possible causes relative to the difficulty, i.e. the laryngoscopic view grade, the muscle relaxant administered during induction, any difficulty of mask ventilation, the eventually successful intubation technique, and the recommendation on the next intubation to the same patient.

About 22% of the patients received various airway techniques for intubation other than laryngoscopic technique in general anesthesia. Laryngoscopic intubation was planned firstly on 8,058 cases; the incidence of difficult intubation was 0.44% (36/8058). Laryngoscopic view was found to be grade 2 in 10 patients, grade 3 in 24, and grade 4 in 2 patients, respectively. In these difficult airway intubations were accomplished ultimately with a conventional laryngoscope in 13 patients, a lighting stylet in 20 patients, a laryngeal mask airway (LMA) in 2 patients, and surface tactile oral intubation (STOI) in 1 patient. As to these patients with difficult airways who would undergo general anesthesia with endotracheal intubation next time awake intubation was suggested only to 4 patients.

In elective general anesthesia, frequent use of the alternative airway techniques, such as LMA for a surgical procedure of short duration and lighting stylet for a possibly difficult airway, will decrease the events of difficult intubations. Lighting stylet seems more advantageous than laryngoscope in management of difficult intubation caused by poor laryngoscopic view.