Blind oral intubation: the development and efficacy of a new approach.

STUDY

OBJECTIVE

To develop an approach to blind oral intubation. With the aid of a fiberoptic laryngoscope and stylet within an endotracheal tube, a video camera, a monitor, and a recorder to correlate the effects of various manipulations of the airway on access to the trachea, a suitable approach was devised. We then evaluated its efficacy.

DESIGN

Randomized, prospective comparison of regimens.

SETTING

Inpatient surgery at a university-affiliated teaching hospital.

PATIENTS: One hundred adult patients with no known abnormalities of the upper airway by history or on physical examination, scheduled to undergo elective surgery, and without evidence of major cardiac disease or need for a rapid-sequence induction of anesthesia.

INTERVENTIONS: Fifty patients in each of two groups were given fentanyl 5 micrograms/kg intravenously (IV), followed 2 minutes later by thiopental sodium 5 mg/kg and succinylcholine 2 mg/kg. Patients in Group 1 (the controls) were orally intubated via direct laryngoscopy using a Macintosh #3 blade. Patients in Group 2 (the experimentals) were intubated orally with the approach developed without the use of a laryngoscope. Intubations were deemed successful if they were performed within 1 minute after the mouth was opened.

MEASUREMENTS AND MAIN

RESULTS

All the patients in Group 1 were successfully intubated within 1 minute, while 49 of the 50 patients in Group 2 were successfully intubated within 1 minute.

CONCLUSIONS

Blind oral tracheal intubation can be successfully performed in a safe and effective manner after appropriate teaching of the technique.