Fiber optic intubation is recommended as the safest technique for protecting the airway in difficult intubation situation (Wulf et al., 1997).Ī variety of oropharyngeal intubation devices have been designed including the Ovassapian®, Williams®, and Berman II® airways, and the PatilSyracus® mask. Oral fiber optic intubation with a modified bite block performed under spontaneous ventilation is safer and more effective than traditional fiber optic intubation for patients with limited neck mobility.Īirway management for patients with limited neck mobility can be challenging to the anesthesiologist and may lead to cannot ventilate-cannot intubate scenarios. The quality of intubation field shows a significant difference in p value between MB and TR groups with the best result observed in MB. The time to successful intubation was significantly shorter in the MB group than in the TR group. Hemoglobin oxygen saturation was significantly greater in the MB group than in the TR group. Resultsīoth groups showed statistically significant increases from baseline in mean arterial pressure and heart rate during the first 3 min after intubation this increase was marked in the TR group than in the MB group. In group MB, the fiber optic was inserted through a modified bite block.

In group TR, the traditional technique of oral fiber optic intubation was performed without the use of a bite block. Sixty adult patients with limited neck mobility who were to undergo elective surgery with mandatory tracheal intubation under spontaneous ventilation were assigned to two groups. Here, we performed fiber optic intubation without and with a bite block that was modified to compare the safety and efficacy of the two techniques. Insertion of the fiber optic bronchoscope through a modified bite block might facilitate intubation in such patients. Fiber optic intubation is the safest solution but can be difficult in patients with limited neck mobility.

It also provides stability to withstand the load of angle connector and ventilator circuit particularly in neonate and children.One critical aspect of anesthesia is to provide airway management. Long integral bite block (as in other size of LMA ProSeal) helps in providing good vertical stability and axial strength during insertion. The initial reports described instability during insertion of the size 1 ProSeal was without a bite block but later a bite block was incorporated by the manufacturer with integral bite block only 1/6 of shaft length. There are limited studies and case reports available in relation to size 1 LMA ProSeal. Often, we observed that the bite block of size 1 LMA ProSeal stays outside the mouth in neonate and infant. This is probably because the integral bite block is only 1/6 of shaft length of LMA ProSeal 1. All described it as more ‘’flimsy’’/’’unstable’’ compared with other pediatric sizes. Over last 3 years, residents and consultants in our institution, encountered difficulty in insertion of the size 1 LMA ProSeal by digital insertion method (neonates/infants up to 5 kg). The integral bite block constitutes more than one third of the shaft of all sizes of LMA ProSeal except size 1. However, in our experience, the digital insertion method is more commonly used. The LMA ProSeal introducer blade has been provided in order to avoid putting the operator's hands in the patient's mouth during insertion of the device. One of the important contributors to the stability of the laryngeal mask airway (LMA) ProSeal during insertion is its integral bite block, particularly when used without introducer blade.

Pediatric bite block