Manoeuvres performed to facilitate fibreoptic orotracheal intubation under general anesthesia. Could be any of them considered as more effective?

ABSTRACT

Our study compared the effectiveness between two of the proposed as rescue manoeuvres to overcome difficulty, in advancing a tracheal tube, during railroading over the fibreoptic bronchoscope. A ninety degrees anti-clockwise rotation (90ΑCWR) of the tube or cricoid cartilage pressure application (CCPA) was randomly performed in eighty patients undergoing fibreoptic orotracheal intubation under general anaesthesia, in whom first attempt to railroad the tracheal tube had failed. 90ΑCWR manoeuvre was successful in 28 of 40 patients (70%), while CCPA was successful in 24 of 40 patients (60%), p=0.07. Intubation times for groups 90ΑCWR and CCPA were 79±13 sec and 85±13 sec respectively and were comparable (p=0.19). Either 90ΑCWR or CCPA manoeuvre is equally effective to facilitate tracheal intubation in a significant number of patients, when difficulty in passing a tracheal tube over an orally inserted fibrescope, under general anaesthesia, occurs.