title: Making endotracheal intubation easy and successful, particularly in unexpected difficult airway.
abstract: BACKGROUND
  Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians.
  
  
  OBJECTIVE
  We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study.
  
  
  METHODS
  Operating room, emergency department, intensive care unit (ICU), retrospective observational study.
  
  
  METHODS
  A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise.
  
  
  METHODS
  Descriptive.
  
  
  RESULTS
  Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists.
  
  
  CONCLUSIONS
  The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany.
authors.forename: Sina
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Department of Anesthesiology, Marienkrankenhaus Papenburg, A Teaching Hospital of the University Medical School, Hannover, Germany.
authors.forename: Karl-Peter
authors.initials: KP
authors.lastname: Schwemm
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Eckhardt
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Department of Anesthesiology, Marienkrankenhaus Papenburg, A Teaching Hospital of the University Medical School, Hannover, Germany ; Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Walied
authors.initials: W
authors.lastname: Abdulla
keywords: Airway management; bougie; difficult intubation; tracheal tube introducer
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