Potential Difficult Airway

[DrRobert]

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Just wondering how some of the veterans on here like to deal with a potential difficult airway for an elective case based on the airway exam, not a known difficult airway from a previous anesthetic record.

Some of the solutions I've seen so far:

1. Awake fiberoptic with topicalization.

2. Standard induction - if you can mask ventilate, give relaxant and do an asleep fiberoptic.

3. Breathe down with Sevoflurane, take a look with DL. If you get a decent view put the tube in. If not, wake the patient up and do a fiberoptic.

4. Awake Glidescope with topicalization.

5. Standard induction - if you can mask ventilate, give relaxant and do an asleep Glidescope.

6. Fast-track LMA.

7. Standard induction - if you can mask ventilate, give relaxant and do DL with a bougie nearby.

 

[Planktonmd]

Just wondering how some of the veterans on here like to deal with a potential difficult airway for an elective case based on the airway exam, not a known difficult airway from a previous anesthetic record.

Some of the solutions I've seen so far:

1. Awake fiberoptic with topicalization.

2. Standard induction - if you can mask ventilate, give relaxant and do an asleep fiberoptic.

3. Breathe down with Sevoflurane, take a look with DL. If you get a decent view put the tube in. If not, wake the patient up and do a fiberoptic.

4. Awake Glidescope with topicalization.

5. Standard induction - if you can mask ventilate, give relaxant and do an asleep Glidescope.

6. Fast-track LMA.

7. Standard induction - if you can mask ventilate, give relaxant and do DL with a bougie nearby.

It all comes down to 1 question in my opinion:
Is this a difficult mask ventilation or only a difficult direct laryngoscopy?
If I feel that it's going to be a difficult intubation and difficult ventilation as well I tend to go directly to an elegant well prepared awake FOB (a rare situation).
If I am anticipating difficult DL but does not appear to be a difficult mask ventilation then just induce GA and do 1 attempt with your favorite blade, if not successful i usually go immediately to asleep FOB because I am good at it but any alternative of the ones you mentioned could be OK.

 

[Gas]

If there is a doubt of ventilation, I have the difficult airway cart in the room. Premedicate with nebulized lidocaine and some glyco. Key is to keep them spontaneously breathing. 100% O2 mask, versed, fentanyl, titrate low doses in slowly to keep out of trouble. Patient should be drowsy, but still able to respond. A little ketamine, some cetacaine spray, sometimes 1-2cc propofol, some sevo, and take a look with DL or Glidescope, and depends what I see. If you feel you can intubate, do it, or induce and then intubate. If not, proceed with FOB or alternative airway device. If you get into trouble, turn off sevo, give narcan/flumazenil, and sit the patient up.

One point of caution - these obese patients with large necks/OSA signs and symptoms can fool you. Their airway can look decent, and then collapse on you after induction of GA. That is where the experience/clinical judgement comes in, and I have a low threshold to do an awake FOB in those patients because ventilating them is not fun.

 

[fastosprintini]

propofol, fentanyl, sux followed by bullard intubation

 

[cchoukal]

I'm a resident at a program in the midwest. Our default is usually awake FOB. I feel like I get good results with topicalization (solution, ointment, then solution sprayed via FOB working channel as I go), as opposed to percutaneous nerve blocks, plus glyco and midaz. Have occasionally done intubating LMAs (with or without the handy video screen attachement), but just for learning, not on people with difficult exams.

Would like to try more glidescope and bougie approaches...

 

[coprolalia]

Would like to try more glidescope and bougie approaches...

Glidescope data claims a Grade I or Grade II view >99% of the time. I don't know what you do with that other <1%, but I've yet to encounter it. The only trouble (occassionally) is finagling the tube into the right spot even with a good view.

-copro

 

[cchoukal]

I agree; the couple times I've used it or its various congeners (the LMA company makes a hand-held video laryngoscope that's pretty cool; screen mounted right on the handle), the view has been great, but manipulating the tube into the front hole was difficult.

 

[fastosprintini]

anybody here uses the bullard routinely?
in our group it's the standard approach for difficult AW's, sofar there were no misses (fasto knocks on wood...)
what are your experiences with it? fasto

 

[urge]

anybody here uses the bullard routinely?
in our group it's the standard approach for difficult AW's, sofar there were no misses (fasto knocks on wood...)
what are your experiences with it? fasto

It sucks!!

I tried 10 times on easy airways. Saw the cords on 1 pt. Could not get the tube in.

Never looked at it again.

 

[Planktonmd]

Glidescope data claims a Grade I or Grade II view >99% of the time. I don't know what you do with that other <1%, but I've yet to encounter it. The only trouble (occassionally) is finagling the tube into the right spot even with a good view.

-copro

The Glidescope is a great gadget and most of the times you get a good view although I disagree with the 99% number, and getting a view does not autamatically mean that you will get the tube in.
As someone on this board had said a while ago: the glidescope is a CRNA intubation tool, they just love it!
I still think that flexible FOB remains the gold standard in advanced airway management.

 

[Planktonmd]

It sucks!!

I tried 10 times on easy airways. Saw the cords on 1 pt. Could not get the tube in.

Never looked at it again.

My experience as well, but there are people out there who can intubate anything, including the pregnant ant jet always mentions, with a Bullard and swear by it.

 

[jwk]

Glidescope data claims a Grade I or Grade II view >99% of the time. I don't know what you do with that other <1%, but I've yet to encounter it. The only trouble (occassionally) is finagling the tube into the right spot even with a good view.

-copro

Try the Glidescope PLUS the bougie.

 

[jwk]

anybody here uses the bullard routinely?
in our group it's the standard approach for difficult AW's, sofar there were no misses (fasto knocks on wood...)
what are your experiences with it? fasto

Garbage device. It's sits in our airway cart unused for years. The Glidescope is the bomb, especially since it now comes in more than one size.

 

[Noyac]

The Glidescope is a great gadget and most of the times you get a good view although I disagree with the 99% number, and getting a view does not autamatically mean that you will get the tube in.
As someone on this board had said a while ago: the glidescope is a CRNA intubation tool, they just love it!
I still think that flexible FOB remains the gold standard in advanced airway management.

I agree that the FOB is still the Gold Standard but the Glidescope is rapidly closing the gap, at least for me.

I had a pt the other day with a large pharyngeal mass very friable present to the ER with difficulty breathing. His voice was very odd sounding, like something was in the way. He could not swallow and was holding a plastic bottle full of spit. He was known to our ENT surgeon who saw him 2-3 months earlier for this mass. It was untreatable then. I got the curbside consult in the ICU while dropping off a pt. ICU doc, who has good airway skills, asked if I'd give him a hand with an airway coming from the ER.

The pt arrives in the ICU and the ICU guy says "this ones all yours". Kool

I talk to him and quickly decide this is no airway I'm tackling down here. We go to the OR and start precedex and Lido neb. This guy has a drug history and is scared to death. He took the whole bag of precedex in a matter of 20 minutes and was still fighting. He wasn't fighting us per say but he was adamant that he did not want to be awake for this even if he was numb. I start dilating the nares and pass the FOB. I can't see jack **** except tumor. Not wanting to stir up any bleeding I come out. This isn't working I tell my partner. "No **** Sherlock" he says. Now the guy is sedated well with small doses of propofol and I give it another attempt. All tumor and when I bump it it bleeds like stink. Can't see anything but all of a sudden there is a bubble and I shoot for it. That always works right,not today. I can't pass the cords or whatever the bubble is coming from and just stir up more bleeding. I come out and the guy is obstructing with chest retractions at every breath. I can still mask him though. I say give me that damned glidescope I trying one more time. I never did a DL on this guy so not sure if it would have been as good but I slip the glidescope in and theres blood everywhere. But I see something that looks like an arytenoid way over to the left side. Everyone else can see the screen as well but they are not as convinced as I am at what I see. I grab the tube (I like the bougie idea JWK) and slip it in. It goes somewhere pretty easily and the guys coughs some. Hook it up and ETCO2 comes back. Golden. If this didn't work the next approach was semi awake track. We trach'd him next.

ENT buddy finds me the next day or so and says "I hear you tube so and so, nice shot, I couldn't see **** 3 months ago." I say "Piece of cake". 😉

 

[rn29306]

The bougie and GS combo works very well together. We have changed to using this combination rather than awake FO almost altogether.

I have met this 1% that GS talks about and would post it if anyone is interested. Long story and I don't have time now at work.

As far as introducing a tube straight into the trachea with the GS, some bend the tube into a corkscrew and some do a significant hockey stick. Hockey stick goes in at a 90 degree so that you don't lose your angle getting in place, then rotate 90 to align yourself with the cords. The one problem that is sometimes encountered is when the stylete is removed and you try to advance the tube, the unsupported tube tends to bend at the cords instead of advancing into the trachea. This is where a good corkscrew rotation and some lube come in handy rather than a straight push.

 

[Planktonmd]

The bougie and GS combo works very well together. We have changed to using this combination rather than awake FO almost altogether.

I have met this 1% that GS talks about and would post it if anyone is interested. Long story and I don't have time now at work.

As far as introducing a tube straight into the trachea with the GS, some bend the tube into a corkscrew and some do a significant hockey stick. Hockey stick goes in at a 90 degree so that you don't lose your angle getting in place, then rotate 90 to align yourself with the cords. The one problem that is sometimes encountered is when the stylete is removed and you try to advance the tube, the unsupported tube tends to bend at the cords instead of advancing into the trachea. This is where a good corkscrew rotation and some lube come in handy rather than a straight push.

Exactly!
It's a CRNA tool.

 

[Noyac]

The bougie and GS combo works very well together. We have changed to using this combination rather than awake FO almost altogether.

I have met this 1% that GS talks about and would post it if anyone is interested. Long story and I don't have time now at work.

As far as introducing a tube straight into the trachea with the GS, some bend the tube into a corkscrew and some do a significant hockey stick. Hockey stick goes in at a 90 degree so that you don't lose your angle getting in place, then rotate 90 to align yourself with the cords. The one problem that is sometimes encountered is when the stylete is removed and you try to advance the tube, the unsupported tube tends to bend at the cords instead of advancing into the trachea. This is where a good corkscrew rotation and some lube come in handy rather than a straight push.

So when you get to the cords could you explain again just how to pass the tube. You lost me here.🙄

 

[rn29306]

I'll be sure to tell my 26 attendings who favor this device this statement. I'm sure they'll get the same kick out of it as you do slamming CRNAs that use alternative devices. As a practice in a trauma setting, we all use the GS over FO 99.99% of the time. Works well for us. Call it what you want.

So lets see: damned CRNAs always use the Miller and F things up....damned CRNAs like to use the GS and its a crutch. I'll just go back to using the Shakani and make everyone happy.

 

[rn29306]

So when you get to the cords could you explain again just how to pass the tube. You lost me here.🙄

Bend the distal tube into the hockey stick shape. Introduce the bent ETT in a horizontal plane with your hand over the right of the patient's mouth. Once in the pharynx, rotate your right hand into the traditional place above the patient's nose or mouth. It seems to allow you to keep the hockey stick position without the need to straighten the angle up in order to get the tube into the mouth. If you need the angle, then fine, its already in place. If not, insert the tip of the ETT into the vocal cords and then remove the stylette and advance it as you see fit.

This is what the director of the anesthesia practice requests and it works quite well. Most times the angle isn't needed as the GS does a good job of giving you proper visualization of the vocal cords.

Most people love the GS but complain that it is hard to instrument the ETT into the trachea, especially if the view of of posterior cords. This way of bending it in combination with a bougie as backup works quite well.

 

[urge]

I'll just go back to using the Shakani and make everyone happy.

Shikani. That is good stuff IMHO!



PS- You use the Miller, don't you?

 

[Planktonmd]

I'll be sure to tell my 26 attendings who favor this device this statement. I'm sure they'll get the same kick out of it as you do slamming CRNAs that use alternative devices. As a practice in a trauma setting, we all use the GS over FO 99.99% of the time. Works well for us. Call it what you want.

Ok,
Let me tell you what the deal is:
You and your 26 "attendings" favor the Glidescope because you don't have the skills needed to do Fiberoptic intubations not because it's better for the patient!
So it is actually better for the patient in your hands and in the hands of your 26 attendings.
It is a simple device and good for people with limited skills.
At the end of the day the best intubation technique is the one that you are more comfortable and more successful with, and for someone with limited skills the glidescope is probably the best choice.

 

[jwk]

Ok,
Let me tell you what the deal is:
You and your 26 "attendings" favor the Glidescope because you don't have the skills needed to do Fiberoptic intubations not because it's better for the patient!
So it is actually better for the patient in your hands and in the hands of your 26 attendings.
It is a simple device and good for people with limited skills.
At the end of the day the best intubation technique is the one that you are more comfortable and more successful with, and for someone with limited skills the glidescope is probably the best choice.

Well plank - I do both FOB and Glidescope (and lightwand, bougie, LMA FastTrach, and whatever other toys I can get my hands on). Indeed, what's best is the technique/device that you are comfortable and most successful with. In my hands, only 29 years in anesthesia and still learning tricks, I'll have the tube in with the Glidescope long before the FOB guys have even finished their nebulized lidocaine.

 

[rn29306]

Shikani. That is good stuff IMHO!



PS- You use the Miller, don't you?

haha...i had to.

i'm a mac fan.

 

[DrRobert]

It seems the Glidescope is gaining in popularity. Do most private practice groups have access to this tool?

 

[rn29306]

Ok,
Let me tell you what the deal is:
You and your 26 "attendings" favor the Glidescope because you don't have the skills needed to do Fiberoptic intubations not because it's better for the patient!
So it is actually better for the patient in your hands and in the hands of your 26 attendings.
It is a simple device and good for people with limited skills.
At the end of the day the best intubation technique is the one that you are more comfortable and more successful with, and for someone with limited skills the glidescope is probably the best choice.

Funny you have such insight to our practice.

In a busy ATC practice in a trauma hospital, the GS is faster and better than the traditional FO. Less prep time by far and doesn't tie up the MDs while covering 1:4.

Use what you want and don't assume you know our practice.

 

[Noyac]

Bend the distal tube into the hockey stick shape. Introduce the bent ETT in a horizontal plane with your hand over the right of the patient's mouth. Once in the pharynx, rotate your right hand into the traditional place above the patient's nose or mouth. It seems to allow you to keep the hockey stick position without the need to straighten the angle up in order to get the tube into the mouth. If you need the angle, then fine, its already in place. If not, insert the tip of the ETT into the vocal cords and then remove the stylette and advance it as you see fit.

This is what the director of the anesthesia practice requests and it works quite well. Most times the angle isn't needed as the GS does a good job of giving you proper visualization of the vocal cords.

Most people love the GS but complain that it is hard to instrument the ETT into the trachea, especially if the view of of anterior cords. This way of bending it in combination with a bougie as backup works quite well.

Hey RN did you see the 🙄 Thats my eyes rolling in my head. Do you really think I need tips on how to pass the ETT through the cords? Really!🙄

 

[Planktonmd]

Well plank - I do both FOB and Glidescope (and lightwand, bougie, LMA FastTrach, and whatever other toys I can get my hands on). Indeed, what's best is the technique/device that you are comfortable and most successful with. In my hands, only 29 years in anesthesia and still learning tricks, I'll have the tube in with the Glidescope long before the FOB guys have even finished their nebulized lidocaine.

I am sure you can intubate faster using the glidescope, actually I am pretty sure I can intubate much faster than your glidescope using a MAC4 maybe even before you turn on your glidescop. 🙂
The point is: if you feel that a certain device in your hands is successful then by all means use it, but don't come on a forum like this one telling us that other well established techniques are inferior because many times the problem is not the technique but rather the operator.
And when someone wants to come on a forum of anesthesiologists and start teaching a technique they need to know a little bit of anatomy and realize that on direct laryngoscopy you see the posterior larynx then the anterior not the other way around.( I am referring to the educational post on how to overcome glidescope difficulties).
I am not trying to start an anti CRNA discussion but if you are a CRNA and you you want to teach us something you need to know what you are talking about and then no one will object.

 

[toughlife]

but it didn't do a damn thing for one of our pts two days ago who was undergoing biopsy of a hypopharyngeal mass and had trismus with 1.5cm mouth opening. Awake, nasal FOB intubation was the only way in.

 

[Planktonmd]

Funny you have such insight to our practice.

In a busy ATC practice in a trauma hospital, the GS is faster and better than the traditional FO. Less prep time by far and doesn't tie up the MDs while covering 1:4.

Use what you want and don't assume you know our practice.

What's an ATC?

 

[rsgillmd]

Glidescope data claims a Grade I or Grade II view >99% of the time. I don't know what you do with that other <1%, but I've yet to encounter it. The only trouble (occassionally) is finagling the tube into the right spot even with a good view.

-copro

Copro, are you using the stylette that comes with it? I haven't had any problems so far. But since the stylette is stiff, I pull it once the tip of my tube is wedged between the cords.

If you are not using the GS stylette, take the one you have and shape it to approximate the curve of the blade.

 

[rn29306]

Hey RN did you see the 🙄 Thats my eyes rolling in my head. Do you really think I need tips on how to pass the ETT through the cords? Really!🙄

Figured you would get a kick outta that.

😴

 

[rsgillmd]

Ok,
Let me tell you what the deal is:
You and your 26 "attendings" favor the Glidescope because you don't have the skills needed to do Fiberoptic intubations not because it's better for the patient!....

Come on, that's a bit harsh. That sounds like something MilMD would say.

I agree with your last sentence though about using what you are most comfortable with. The first day we had GS a couple of months ago, I had a potentially difficult airway. I secured it with an awake fiberoptic b/c I had never used the GS on real patient as of that date.

I'm comfortable with the fiberoptic scope, but I have since then grown very comfortable with the GS. Sometimes I need a little cricoid pressure to get the best view, but I have always had a Grade I or II view in the end, and have always been able to get the tube in so far.

Now that I'm comfortable with the GS, I've gone back to periodically doing elective fiberoptic intubations in order to not lose my fiberoptic skills.

 

[Planktonmd]

Come on, that's a bit harsh. That sounds like something MilMD would say.

Yes, it might be harsh but it's reality.
I have seen it in this business so many times:
People criticize a certain technique or procedure just because they are not good at it.
it's common to see people saying: I hate interscalene blocks, or I hate lateral popliteal blocks....etc...
These statements actually mean: I suck at these procedures but I am in denial.

 

[jwk]

I am sure you can intubate faster using the glidescope, actually I am pretty sure I can intubate much faster than your glidescope using a MAC4 maybe even before you turn on your glidescop. 🙂
The point is: if you feel that a certain device in your hands is successful then by all means use it, but don't come on a forum like this one telling us that other well established techniques are inferior because many times the problem is not the technique but rather the operator.
And when someone wants to come on a forum of anesthesiologists and start teaching a technique they need to know a little bit of anatomy and realize that on direct laryngoscopy you see the posterior larynx then the anterior not the other way around.( I am referring to the educational post on how to overcome glidescope difficulties).
I am not trying to start an anti CRNA discussion but if you are a CRNA and you you want to teach us something you need to know what you are talking about and then no one will object.

Ah, touche' - hey, it's just a little clinical discussion. I thought MAC 4's were the blade of choice for gravid fireants - oh wait, that's just Jet.

 

[jwk]

ENT buddy finds me the next day or so and says "I hear you tube so and so, nice shot, I couldn't see **** 3 months ago." I say "Piece of cake". 😉

Never let them see you sweat. 👍

 

[jwk]

It seems the Glidescope is gaining in popularity. Do most private practice groups have access to this tool?

We've got about 10 of them now - 2 in each major unit that we work.

And although I assume every anesthesia department has or has access to an FOB, they are rather pricey. As I recall, Glidescopes are in the $8000 range. We use the FOB maybe once or twice a week tops, but we use the Glidescope multiple times daily. Our latest indication is when we are placing NIMS ETT's - our ENT surgeons actually want us to use the Glidescope so they can personally watch the TV screen and see that blue band and wires sitting between the cords - they don't want to take our word for it. It's a shame we can't charge extra for it.

 

[Noyac]

We've got about 10 of them now - 2 in each major unit that we work.

And although I assume every anesthesia department has or has access to an FOB, they are rather pricey. As I recall, Glidescopes are in the $8000 range. We use the FOB maybe once or twice a week tops, but we use the Glidescope multiple times daily. Our latest indication is when we are placing NIMS ETT's - our ENT surgeons actually want us to use the Glidescope so they can personally watch the TV screen and see that blue band and wires sitting between the cords - they don't want to take our word for it. It's a shame we can't charge extra for it.

We have one for 7 anesthesiologists. I'm really surprised that you guys use it so much. Are there really that many difficult airways? I understand the ENT scenario but other than that you guys are getting a lot of use from that device.

Yeah, never let them see you sweat. Its all in the appearance. 👍

 

[Planktonmd]

Ah, touche' - hey, it's just a little clinical discussion. I thought MAC 4's were the blade of choice for gravid fireants - oh wait, that's just Jet.

Mac 4's are the blades of choice for gravid fire ants and micrognathic amoebae.

 

[proman]

I have an attending who only uses a Bullard. Has done >4000 intubations with it. He claims he only needs a 2 cm mouth opening. I've tried it and hate it. For the unanticipated difficult airway I think the LMA with fiberoptic/Aintree combo is great and highly reliable. The intubating LMA was a major letdown.

 

[rn29306]

What I wrote was simply what works at my facility at the practice where I work. It wasn't meant to be a broad, sweeping statement about how GS is superior to FO for everyone's practice. Use what works for you. We utilize the GS, much like JWK's practice. I thought I had implied the 'our practice' issue enough, obviously not.

It was actually generated in response to post #5 (using the GS and bougie combination) and #6, and 7 (manipulating an OETT).

Alotta people besides you attendings read these forums and perhaps it could help someone with manipulation.

I ain't a 'hater'.

 

[jetproppilot]

These statements actually mean: I suck at these procedures but I am in denial.

HAHAHAHAHAHAHAHAHAHA

Funny, Planky.

True too.

 

[fastosprintini]

I have an attending who only uses a Bullard. Has done >4000 intubations with it. He claims he only needs a 2 cm mouth opening. I've tried it and hate it. For the unanticipated difficult airway I think the LMA with fiberoptic/Aintree combo is great and highly reliable. The intubating LMA was a major letdown.

hi proman, no, you do need only 1 cm or less of mouthopening (look at the bullard in profile, you will see that the widest part is the tube !)
most people who get started with it run into problems because they do not put the plastic extender on it (i know, kind of pricey but it turns a 2.5 mac into a real #3 mac blade) ,and/or fail to properly warm the instrument in a bairhugger to avoid fogging up due to the high thermal mass . give it another try, where i trained we had a large (sic) bariatric program, all of them went asleep and had a rapid sequence bullard intubation. fasto

 

[coprolalia]

Copro, are you using the stylette that comes with it? I haven't had any problems so far. But since the stylette is stiff, I pull it once the tip of my tube is wedged between the cords.

If you are not using the GS stylette, take the one you have and shape it to approximate the curve of the blade.

I don't use the GS stylet. Use just a reg-u-lar old stylet. Bend like a hockey stick. Place against the cords. Put the tip in. Pull the stylet and advance the tube.

Hasn't failed me yet (and I know how to intubate with all the other tools... even the POS Shikani).

-copro

 

[core0]

What's an ATC?

Air Traffic Control. The anesthesiologist sits in a little tower and tells people where to go. I think thats what I saw last night in Central Florida.

David Carpenter, PA-C

 

[numbmd]

Does it really matter which technique you use if you actually GET the airway?
I don't give a s*** if you use a tongue blade and a flashlight. As long as it works.

If there are older guys they might remember a time when there would be an occasional difficult airway that would emergently require a call for help. Never happens in our place any more. Between Bullard, Glide, McGrath, Wu, FOB, or Intubating LMA, getting the airway is easier now-a-days.

True story bout the tongue blade and a flashlight. Taught to me by a guy that used to do open drop halothane!

 

[Noyac]

Does it really matter which technique you use if you actually GET the airway?
I don't give a s*** if you use a tongue blade and a flashlight. As long as it works.

If there are older guys they might remember a time when there would be an occasional difficult airway that would emergently require a call for help. Never happens in our place any more. Between Bullard, Glide, McGrath, Wu, FOB, or Intubating LMA, getting the airway is easier now-a-days.

True story bout the tongue blade and a flashlight. Taught to me by a guy that used to do open drop halothane!

My old man can intubate blindly with his fingers. He's a pediatrician and I've never seen him miss. He never uses a blade. Just how he was taught. I guess anything is possible.

 

[numbmd]

Blind nasal? or oral?
In kids?
Do tell, do tell.

I was also taught to do a blind oral by putting your index and third finger in the airway and guiding the tube over your fingers, through the cords. I can only do it in edentulous patients because of my hamhock hands.

Is that how your old man did it?

 

[Noyac]

Blind nasal? or oral?
In kids?
Do tell, do tell.

I was also taught to do a blind oral by putting your index and third finger in the airway and guiding the tube over your fingers, through the cords. I can only do it in edentulous patients because of my hamhock hands.

Is that how your old man did it?

Exactly

 

[sevo85288]

Just as an interesting aside, the oldest partner in my practice has never used a fiberoptic, FastTrac, GS, bullard, etc. He intubates everyone with a MAC 3 and Hollinlock (sp?). He laughs when we are discussing difficult airways; he claims to never a a difficult intubation. At first I didn't believe it; but it's true; he can intubate anyone with his MAC 3 blade and Hollinlock.

 

[coprolalia]

Just as an interesting aside, the oldest partner in my practice has never used a fiberoptic, FastTrac, GS, bullard, etc. He intubates everyone with a MAC 3 and Hollinlock (sp?). He laughs when we are discussing difficult airways; he claims to never a a difficult intubation. At first I didn't believe it; but it's true; he can intubate anyone with his MAC 3 blade and Hollinlock.

Yeah, sure. There's a few post-glossectomy ex-XRT patients I've stumbled across that I'd like to introduce him to...

And, then, of course, there's patients like this...

"Overconfidence breeds carelessness."
Confuscius

-copro