Hybrid intubation technique for the management of a difficult airway: a case report

There are circumstances when induction of general anesthesia followed by direct laryngoscopy and intubation is contraindicated. This case report describes and presents a protocol for a method of endotracheal intubation that combines the benefits of light wand and fiberoptic techniques. The patient was a 73-year-old male with a history of two cervical fusions. He was reported to be "unintubatable" at the time of his last surgery. A physical examination revealed limited neck extension. Awake endotracheal intubation was accomplished by a hybrid technique, using a light wand and fiberoptic bronchoscope simultaneously. The light wand facilitated positioning of the endotracheal tube at the glottis and provided surface clues concerning the position of the tip of the endotracheal tube. The bronchoscope allowed direct visualization of the pharyngeal, laryngeal, and tracheal anatomy. Since our initial experience, the hybrid technique has been modified by replacing the light wand with a conventional stylet. Subsequent uses of the technique have been successful and free of complications.