A novel method of intubation and orogastric tube insertion using a C-MAC-D-blade videolaryngoscope-bougie technique

Expertise in airway management is a fundamental aspect of anesthesia practice. Fortunately 'can't intubate, can't ventilate' scenarios are extremely rare. In particular, patients with tumors on the right side of the oropharynx and larynx can be very problematic to intubate.

We present an alternative intubation technique, whereby a C-MAC D-blade videolaryngoscope is loaded with a Frova catheter in the narrow, curving channel within the blade's infero-posterior aspect on the left side of the blade. This technique can be a successful alternative in patients with difficult airways.

The proposed technique was successfully demonstrated in a case whereby a 47-year old male with premetrics of a difficult airway, presented with a large mass in the right supraglottis and hypopharynx with through-and-through thyroid cartilage infiltration, obstructing completely the view of the glottis with direct laryngoscopy. The referral hospital considered the patient unintubatable and sent the patient to our academic center for treatment. Endotracheal intubation with the new technique was successful at the first attempt.

The C-MAC D-Blade videolaryngoscope-bougie technique provides an alternative method to intubate patients with difficult airways, even in exceptional situations such as in patients with a large right-sided oropharynx-larynx tumor.