title: Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial.
abstract: OBJECTIVE
  Flexible fiber-optic bronchoscope-guided orotracheal intubation is a valuable technique with demonstrated benefits in the management of difficult airways. Despite its popularity with anesthesia providers, the technique is not fail-safe and airway-related complications secondary to failed intubation attempts remain an important problem. We sought to determine the effect of incorporating lingual traction on the success rate of fiber-optic bronchoscope-guided intubation in patients with anticipated difficult airways.
  
  
  METHODS
  In this prospective, randomized, cohort study, we enrolled 91 adult patients with anticipated difficult airways scheduled for elective surgery to undergo fiber-optic bronchoscope-guided orotracheal intubation alone or with lingual traction by an individual anesthesiologist after induction of general anesthesia and neuromuscular blockade. A total of 78 patients were randomized: 39 patients to the fiber-optic bronchoscope-guided intubation with lingual traction group and 39 patients to the fiber-optic bronchoscope-guided intubation alone group. The primary endpoint was the rate of successful first attempt intubations. The secondary outcome was sore throat grade on post-operative day 1.
  
  
  RESULTS
  Fiber-optic intubation with lingual traction compared to fiber-optic intubation alone resulted in a higher success rate (92.3 vs. 74.4 %, χ (2) = 4.523, p = 0.033) and greater odds for successful first attempt intubation (OR 4.138, 95 % CI 1.041-16.444, p = 0.044). Sore throat severity on post-operative day 1 was not significantly different but trended towards worsening grades with lingual traction.
  
  
  CONCLUSIONS
  In this study, lingual traction was shown to be a valuable maneuver for facilitating fiber-optic bronchoscope-guided intubation in the management of patients with anticipated difficult airways.
authors.affiliation: University of South Florida Morsani College of Medicine, 1 Tampa General Circle, Tampa, FL, 33606, USA, yching@outlook.com.
authors.forename: Yiu-Hei
authors.initials: YH
authors.lastname: Ching
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Karlnoski
authors.forename: Henian
authors.initials: H
authors.lastname: Chen
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Camporesi
authors.forename: Vimal V
authors.initials: VV
authors.lastname: Shah
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padhya
authors.forename: Devanand
authors.initials: D
authors.lastname: Mangar
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D000769:Anesthesia, Inhalation / Q000379:methods; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D014059:Tongue; D014143:Traction / Q000379:methods*; D016896:Treatment Outcome