One common mistake is to place the blade tip too close to the glottis, especially for novice
intubator.
The likelihood of esophageal intubation increases with emergent situations, class III/IV airways (Modified Mallampati), and level of training of the
intubator.
a) Extension maneuver: pulling back of the metal handle of the ILMA towards the
intubatorIntubation with FFB was done through an orally inserted William's
intubator oral airway(R) size 9 in female and size 10 in male patients.
Because the
intubator was often not present, no attempt was made to compare the measured pressure with a qualitative pressure.
However, the standard LMA was not designed to be used as an
intubator and there are several problems associated with this.
So, inserting an endotracheal tube through such a small opening and under such emergent circumstances, demands the most accomplished
intubator.
sup][3] It is generally believed that only when an optimal laryngoscopy attempt is achieved, difficult laryngoscopy might be readily apparent to a reasonably experienced
intubator on the first attempt and therefore be independent of both number of attempts and time.
Moreover, we note that as the Discopo stylet is a rigid stylet, it may increase risk of soft-tissue damage if the
intubator uses excessive force during the procedure.
A typical example of an experienced
intubator is shown in Figure 3, with a short maximal peak associated with initial glottic exposure and a later prolonged 'plateau phase' of lower magnitude associated with intubation.
There are a number of such airways available including the Berman Intubating Airway (Vital Signs, Totowa, NJ, USA), Ovassapian Fibreoptic Intubating Airway (Kendall, Argyle, New York, NY, USA) and the Williams Airway
Intubator (Williams Airway
Intubator Ltd, Calgary, Canada) (5).
Other devices or procedural factors that hamper the insertion of the endotracheal tube over a fibrescope include the airway
intubator, cricoid pressure or jaw thrusting (19).
