Canadian Journal ofĢ.Bonfils P.Difficult intubation in Pierre-Robin children, a new method: An analysis of laryngoscope blade shapeĪnd design: new criteria for laryngoscope evaluation. Molar intubation is a neglected skill which is extremely useful in aġ.Marks RRD,Hancock R, Charters P. Have been suggested to improve the laryngoscopic view2.I believe that ![]() Rotation of the neck and manipulation of the cricoid cartilage Midline which hamper the laryngeal view in the anterior airway line1 areĪvoided. The advantage of using this technique is that structures in the Most fundamental of airway equipment -a laryngoscope and an endotracheal However ,molar intubation is an easy to master technique that uses the Technique.The large number of supraglottic devices and alternative devicesĪvailable to anesthesiologists have overshadowed laryngoscopic intubation Must be congratulated for managing this case by the described They have described one more use for molar intubation and Thank you for giving me the opportunity to respond to the letter byĪppukutty et al. Intubation was accomplished successfully on the first attempt. OELM was applied and this brought the posterior rim of the glottis into view, although no other laryngeal structure was visible. The laryngoscope was re-introduced through the right angle of the mouth and the tip was directed to the midline into the valleculla. As the patient had three anatomical airway problems in the midline, it was decided to perform laryngoscopy by the right molar approach. The tube was withdrawn and the patient ventilated with the mask. A single blind attempt at intubation with a south pole RAE tube, size 4.5 with a stylet inserted into it, and shaped into a curve with a hockey stick end resulted in oesophageal intubation. Laryngoscopy was performed after adequate positioning with a straight blade (Miller) laryngoscope but no laryngeal structure, including the epiglottis, could be seen even after optimum external laryngeal manipulation (OELM). Glycopyrrolate, meperidine, and succinylcholine were given i.v. As the depth of anaesthesia increased, signs of airway obstruction appeared, but after a Guedel airway was inserted, there were no problems in maintaining the airway or ventilating the lungs. Anaesthesia was induced with oxygen, nitrous oxide, and sevoflurane using a paediatric breathing circuit with mask and end-tidal capnography, pulse oximetry, and cardiac monitor and an i.v. On examination, he had a micrognathic mandible and tongue tie. 5Ī 14-month-old male was scheduled to undergo cleft palate repair. A combination of cleft palate with tongue tie has been reported to cause problems in intubation which was accomplished by the two anaesthetist technique. Reduced tongue mobility has been identified as an independent factor for difficult intubation 4 in five adult patients with reduced tongue mobility who required fibreoptic or retrograde intubation. These children are known to have airway obstruction due to the distorted anatomy and are difficult to mask ventilate and intubate. ![]() ![]() We used this technique to successfully intubate a child with Pierre Robin syndrome, cleft palate, and tongue tie. 2 The advantage of using this technique is that structures in the midline which hamper the laryngeal view in the anterior airway line 3 are avoided. Rotation of the neck and manipulation of the cricoid cartilage have been suggested to improve the laryngoscopic view. The blade is advanced and its tip is made to pass posterior to the epiglottis. In this technique, 1 a straight blade laryngoscope is introduced from the right corner of the mouth along the groove between the tongue and the tonsil, using leftward and anterior pressure to displace the tongue to the left of the laryngoscope. Editor-The right molar approach for laryngoscopy has been described for intubation of patients with a difficult airway as the paraglossal 1 and retromolar 2 technique, respectively.
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