When fiberoptic intubation fails in patients with unstable craniovertebral junctions.

Fiberoptic intubation (FOI) is generally regarded as the preferred method to achieve endotracheal intubation in patients with cervical spine instability. When performed electively, FOI has a very high level of success. Nevertheless, rarely, FOI may fail.

Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation.

Background: Manual in-line stabilization (MILS) is recommended during direct laryngoscopy and intubation in patients with known or suspected cervical spine instability. Because MILS impairs glottic visualization, the authors hypothesized that anesthesiologists would apply greater pressure during intubations with MILS than without.

Methods: Nine anesthetized and pharmacologically paralyzed patients underwent two sequential laryngoscopies and intubations, one with MILS and one without, in random order.

Endoscopic study of mechanisms of failure of endotracheal tube advancement into the trachea during awake fiberoptic orotracheal intubation.

Background: Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiberoptic orotracheal intubation is often impeded. The goal of this study was to identify the sites and mechanisms that inhibit the passing of the ETT into the trachea.

Methods: Forty-five consenting patients underwent a clinically indicated awake fiberoptic orotracheal intubation.

Laryngeal trauma during awake fiberoptic intubation.

We describe three patients with difficult airways in which fiberoptic endotracheal intubation was used to insert breathing tubes into the patients' windpipes. Airway injury occurred during the use of this technique. Although largely a safe technique, care should be exercised when anesthesiologists choose equipment and when they perform this technique.