Difficult intubation deliberation

Last week I posted on a tricky airway requiring AFOI (awake fibre-optic intubation) – see Awake Intubation Procrastination.

I got a bit of correspondence from the readers and a very special reader – Dr James DuCanto, M.D. from Milwaukee, Wisconsin, USA.  (yep, Happy days, the Fonz.. you know the place.)  You will recognize Jim D if you have seen the Emcrit or PHARM blogs – he pops up there with great airway demos on a regular basis.

Jim was keen to show me how he approaches the patient with a predicted “difficult tube” due to poor mouth opening – such as my patient in the above post.

Rather than just describe it – he has sent me (and you) a great demo video of his technique in action.  It is a nice trick – one that might come in handy if you are like me – a very amateur AFOI user, but often in “no-backout” situations. Click below for the multimedia, commentated video:

Recognised Difficult Airway (TMJ) Managed with Oxylator Air-Q and Optical Stylet

Now.  How cool was that – is that not the coolest thing out of Milwaukee since the Fonz?  A purist might say that AFOI is the gold standard, but this is “tiger terrritory” if you are not proficient with a scope and the topicalization involved.

Whilst we are discussing cool stuff (if you are on the nerdy side).  I have to mention my mate Dr Tim (KI Docs) has upgraded his site and gone to a new adress.  He is now at:  (see Blog roll) – add it to your reading list.  Tim is nothing if no interesting, fearless campaigner for rural GPs lot and a major tech, anaesthesia geek.

Tim has just posted on Apps for Airways etc – his own review of a bunch of Apple Apps that come in handy in his practice as a small town GP-anaesthetist.  Check out his reviews – I think I might add a few to my pocket brain.

Amongst the apps was the ANZCA app for all things Anaesthesia – including topicalization of the airway.  I think this might be a way of saving a memory in my brain for the occasional moments when I need o know how to do this.

Dr DuCanto will be answering any questions and giving his time to you all – so watch the video, imagine yourself in your theatre and ask him what you think will be the stumbling block for your practice.  He is a seriously smart, and super nice guy – so get on to the comments and take this opportunity to learn from a master.  Casey



  1. Thanks for the compliment, Casey. Now I know that this technique may appear simple–because it is simple–but don’t try it on a difficult airway until you have tried it on a mannequin, then on a patient with a normal airway. I believe that this technique is a great airway equalizer–it will allow those with optical stylets to achieve airway parity with many specialists. But again, don’t anyone out there go and do something unwise without the proper preparation. Proper preparation will require practice on anesthetized patients with normal airways. And the shape of the stylet needs to to match the Air-Q airway.

    Now, I would like to hear as many questions, no matter how simple, humble or possibly off-the-wall as possible. This will allow you all to get the most out of this exercise, and it will give me the feedback I need as a teacher. As the Fonz would say, “AAAYYYYYYY………”

  2. All good stuff

    Sadly the oxylator is not (yet) available in Australia

    But the Air Q II is (and only about A$30 each) – combines features of the FastTrach iLMA with the gastric drainage port of a ProSeal LMA

    It’s a good device.

    Add to this a malleable stylet for about A$2000 and you have a robust technique

    See also my paper published today on rural GP-anaesthetists and access to difficult airway equipment in Australia for suggestions on robust yet affordable kit for airway management

    Like Master DuCanto says – practice on a mannequin, then on elective lists – then you’ll be ready in a crisis….

    I’ll bung up some videos on in next few weeks, or come talk to me at Rural Medicine Australia 2012 in Fremantle this month – #RMA2012

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