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Correspondence  |   July 2000
A Versatile Alternative to Standard Laryngoscopy
Author Notes
  • Associate Professor
  • University of Illinois at Chicago College of Medicine
  • Acting Chief, Anesthesia Service
  • Chicago VA Hospital
  • Westside Division
  • Chicago, Illinois 60612
  • guyw@uic.edu
Article Information
Correspondence
Correspondence   |   July 2000
A Versatile Alternative to Standard Laryngoscopy
Anesthesiology 7 2000, Vol.93, 309-310. doi:
Anesthesiology 7 2000, Vol.93, 309-310. doi:
To the Editor:—
Conventional laryngoscopy may be difficult for the operator with weakness in the upper extremity used for manipulating the laryngoscope. I recently developed left-sided suprascapular nerve palsy, resulting in atrophy of the infraspinatus muscle. Having no power to perform laryngoscopy with my left arm, I began using an alternative method for tracheal intubation.
Standing along the patient’s right side, I hold the laryngoscope in the right hand, with the blade end of the handle between my thumb and index finger and the blade pointing toward the patient. After induction of anesthesia, the blade is gently inserted into the patient’s mouth, the laryngoscope tip is directed to the base of the tongue, and force is applied to the jaw with a pulling motion that aligns the oropharyngeal and laryngeal axes vertically. Thus, the oropharyngeal axis is pulled to a position anterior to the glottis, and the glottis is viewed by looking directly downward. Because the tube is inserted along a vertical line, I call this technique vertical intubation (fig. 1)
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
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. This method may also provide a mechanical advantage over standard laryngoscopy because one uses very large muscle groups to lift of the jaw.
A similar method, named “inverse intubation” by Guertner, 1 has been described for emergency intubations in the field with the rescuer standing or kneeling over or next to the patient. Hilker et al.  2 reported several cases with limited access to the patient or difficult patient positioning in which the technique provided some advantage over standard laryngoscopy.
Vertical intubation offers excellent exposure of the airway in many patients and may be a useful backup to standard laryngoscopy.
References
Guertner I, Kanz K, Lackner C, Schweiberer L: Inverse intubation beim Polytrauma: Indikation, Technik, Erfahrungen (German). Intensivmedizin 1993; 30:426–7Guertner, I Kanz, K Lackner, C Schweiberer, L
Hilker T, Genzwuerker H: Inverse intubation: An important alternative for intubation in the streets. Prehospital Emergency Care 1999; 3:74–6Hilker, T Genzwuerker, H
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
Fig. 1. Note the direction of insertion of the tracheal tube. Photo courtesy of Dr. Miguel Teresi, Chief of General Surgery, Chicago VA Hospital, Westside Division, Chicago, Illinois.
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