Difficult adult airway and endotracheal intubation

: In 1984, Cormack and Lehane defined laryngoscopic view in four grades. As the view worsens, the difficulty of intubation may increase but it is not clear. In this study, we examined the endotracheal intubation techniques to the grade III or IV airways. Some 48 patients were determined as grade III and IV. In 26 patients the conventional endotracheal intubation technique (conventional technique) was selected. In 20 patients endotracheal intubation was performed over the gum-elastic bougie (bougie technique). In two patients laryngeal mask airway, fiberoptic bronchoscope and handmade flexible guide tube were used as aids to endotracheal intubation (guide technique). Nineteen patients with conventional technique and 6 patients with bougie technique required the external laryngeal pressure. In conclusion, the grade III or IV airways were not always difficult to intubate. But when the conventional technique failed, the gum-elastic bougie or laryngeal mask airway was a fairly useful aid to endotracheal intubation. Moreover our handmade flexible guide tube made the intubation through the laryngeal mask airway safe and reliable.