Tongue Traction is as Effective as Jaw Lift Maneuver for Trachlight-guided Orotracheal Intubation

Umesh, Goneppanavar; Mathew, George; Ramesh, Venkateswaran

doi:10.1016/s1875-4597(10)60044-6

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…[11] Lightwand has also been included in the difficult airway algorithm limb of American Society of Anesthesiologists. [12] Although tongue traction manoeuvre has been found to be as effective as the jaw lift manoeuvre,[13] we studied the jaw lift manoeuvre versus combined tongue and jaw lift manoeuvre as one of the studies has found that the oropharyngeal clearance was better with the combined manoeuvre for fibreoptic guided intubation. [14]…”

Section: Discussionmentioning

confidence: 99%

Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator

2011

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Lightwand-guided intubation is a semi-blind technique that takes advantage of the anterior location of the trachea in relation to the oesophagus. Fibreoptic evaluation of lightwand-guided intubation has revealed a possibility of laryngeal interference and epiglottic distortion. Jaw lift, tongue traction or a combination of both have been used to assist in lightwand-guided intubation. This study fibreoptically evaluates lightwand-guided intubation using jaw lift and combined jaw and tongue traction. Eighty four patients with normal airway undergoing general anaesthesia were studied. This randomised, double blinded, cross over study was done in two phases. First phase – after achieving adequate depth of anaesthesia, a fibrescope was advanced nasally, and lightwand-guided intubation was carried out under direct fibreoptic visualisation with the aid of either jaw lift or combined jaw and tongue traction. Second phase – Extubation followed by reintubation using the other manoeuvre. Interference with laryngeal structures during intubation and position of the epiglottis at the end of intubation were noted. Epiglottic distortion (deviated to one side/infolded into trachea) was observed in 6 patients with jaw lift and 17 patients with combined jaw and tongue traction (P=0.003). Laryngeal interference was significantly higher (P=0.012) with combined manoeuvre (30/78) than with jaw lift alone (9/81). Although lightwand-guided intubation can be performed quickly and easily, interference with laryngeal structures and distortion of the epiglottis can occur. Jaw lift manoeuvre causes less laryngeal interference than combined jaw and tongue traction applied by a single operator.

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Section: Discussionmentioning

confidence: 99%

Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator

2011

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“…In our study, we placed the head in a slightly extended position and used the jaw lift maneuver. This maneuver lifts the tongue and epiglottis away from the posterior pharyngeal wall, thereby creating some space for the passage of gases [17] (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…In some cases of severe short mandible jaw lift maneuver cannot be sufficient. Association of mandible lift and tongue traction is indicated even if fibroscopy aid is used [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…The anesthetist has full control with this kind of operation with no need of the fiberscope use and is therefore not dependent on it, even if an association of the two maneuvers is possible in particularly difficult cases when fibroscopy alone is not sufficient for intubation. Furthermore, tongue traction is a totally non-invasive maneuver which applies semplicity and safety qualities, while both the fiberscope and laryngoscope methods can cause damage in difficult intubation and a subsequent tracheostomy is required [17].…”

Section: Discussionmentioning

confidence: 99%

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Difficult Intubation in Patient with Short Thyromental Distance: Usefulness of Tongue Traction Maneuver

Cortese¹,

Pantaleo²,

Gargiulo³

et al. 2014

J Anesth Clin Res

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Introduction: Short Thyromental Distance (TMD; <5 cm) has been correlated with difficult direct intubation in adult patients. Differences in patient characteristics may influence the incidence of difficult airway intubation, especially in patients with a reduced mandible dimension. We report a case affected by Goldenhar’s syndrome treated for mandibular hypoplasia with difficulties in intubation. Methods: A 25 years old caucasian woman was referred to the Unit of Maxillofacial Surgery of the University of Salerno, with bilateral Goldenhar’s syndrome, planned for a sandwich osteotomy as “chin-wing” mentoplasty following Triaca technique with the aid of the tongue traction maneuver in combination with fibroscopy at intubation time. Following Mallampati classification anesthesiologists, before surgery, classified the airways as easy or difficult according to specified criteria. Discussion: The anesthesiologist’s prediction changed from difficult grade 3 to difficult grade 4 at the time of operation, this because the patient had showed a severe reduction of the mandibular length with the tongue position of the tongue which overlapped the epiglottis making very difficult laryngeal glottis view at the intubation time. Efficacy of the “Tongue traction maneuver” in combination with a planned fibroscopy is reported. High risks of dispnea in short mandible patients at the extubation time after mandible surgery for tongue and pharyngeal swelling are also underlined. Conclusions: Anesthesiologists can derive useful information from facial appearance and facial skeleton, by panoramic X-rays of the jaws, X-ray cephalograms and CT scan analysis that enhances the prediction of a difficult airway intubation. Particularly mouth opening limitations and mandibular operations planning with post-operative tongue and pharyngeal swelling and consequent airway obstruction at the extubation time, have to be carefully evaluated. In craniofacial surgery importance of some maneuvers like “tongue traction” in short thyromental distance alone or in addition to fibroscopy for limited mouth opening cases and a “double step intubation” for narrow nasal airway’s are reported

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Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial

et al. 2014

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Tongue Traction is as Effective as Jaw Lift Maneuver for Trachlight-guided Orotracheal Intubation

Abstract: The tongue traction maneuver is as good as the jaw lift maneuver with regard to the success rate and time taken for Trachlight-guided orotracheal intubation.

Cited by 7 publications

References 9 publications

Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator

Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator

Difficult Intubation in Patient with Short Thyromental Distance: Usefulness of Tongue Traction Maneuver

Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial

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