A comparative study of tracheal intubation using an intubating laryngeal mask (Fastrach) alone or together with a lightwand (Trachlight)

Study Objective: To determine if the Trachlight^TM lightwand can facilitate Fastrach^TM intubation by guiding the tip of the endotracheal tube into the trachea.

Design: Open-label, prospective, randomized, comparative study.

Setting: General operating suites of a tertiary teaching hospital.

Patients: 172 elective surgical patients requiring general anesthesia with endotracheal intubation.

Interventions: With general anesthesia, the Fastrach™, which is a new intubating laryngeal mask airway, was inserted into the oropharynx. Ventilation was ensured before the insertion of an endotracheal tube via the Fastrach™. Tracheal intubation was then performed randomly (coin toss) using either the endotracheal tube alone (Fastrach™ group), or endotracheal tube with the Trachlight, a lightwand (Fastrach/Trachlight™ group). The time to place the Fastrach™ and endotracheal tube, to remove the Fastrach™, and the total time to intubate were recorded. The number of attempts, failures, trauma, sore throats, and hemodynamic changes were also recorded. Data were analyzed using unpaired t-test, ANOVA with repeated measures, or Chi-squares contingency table where appropriate.

Measurements and Main Results: Although there were no differences in the times to place the Fastrach™, and endotracheal tube, the hemodynamic changes, and postoperative complications, there were significantly more attempts and failures in the Fastrach™ group compared to the Fastrach™/Trachlight™ group. There were no differences in the incidence of sore throat and trauma in between the groups.

Conclusions: Although tracheal intubation is effective using a Fastrach™ alone (76% success rate), it is more effective when the Fastrach™ is used in conjunction with the Trachlight™ (95%). These results suggest that the lightwand is a useful adjunct for Fastrach™ intubation. However, the role of Fastrach™ intubation together with the Trachlight™ in the management of patients with a potential difficult airway remains to be determined.     

Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway

Lightwand devices are effective and safe as an aid to tracheal intubation. Theoretically, avoiding direct-vision laryngoscopy could allow for less stimulation by intubation than the conventional laryngoscopic procedure. We designed this prospective randomized study to assess the cardiovascular changes after either lightwand or direct laryngoscopic tracheal intubation in adult patients anesthetized with sevoflurane. Sixty healthy adult patients with normal airways were randomly assigned to one of three groups according to intubating procedure under sevoflurane/nitrous oxide anesthesia (fraction of inspired oxygen = 0.33) (n = 20 each). The lightwand group received tracheal intubation with Trachlight, the laryngoscope-intubation group received tracheal intubation with a direct-vision laryngoscope (Macintosh blade), and the laryngoscopy-alone group received the laryngoscope alone. Heart rate and systolic blood pressure were recorded continuously for 5 min after tracheal intubation or laryngoscopy with enough time to intubate. All procedures were successful on the first attempt. The maximum heart rate and systolic blood pressure values obtained after intubation with Trachlight (114 +/- 20 bpm and 143 +/- 30 mm Hg, respectively) did not differ from those with the Macintosh laryngoscope (114 +/- 20 bpm and 138 +/- 23 mm Hg), but they were significantly larger than those in the laryngoscopy-alone group (94 +/- 19 bpm and 112 +/- 21 mm Hg) (P < 0.05). Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation. IMPLICATIONS: The magnitude of hemodynamic changes associated with tracheal intubation with the Trachlight is almost the same as that which occurs with the direct laryngoscope. Hemodynamic changes are likely to occur because of direct tracheal irritation rather than direct stimulation of the larynx.     

光棒在困难气道患者经鼻气管插管中的应用

目的探讨光棒在困难气道患者经鼻气管插管中的应用效果。方法选取困难气道且拟行经鼻气管插管患者131例,男62例,女69例,年龄18～60岁,ASAⅠ或Ⅱ级,采用随机数字表法分为纤维支气管镜组(F组,n=66)和光棒组(L组,n=65)。比较两组插管成功率、插管时间及术后插管并发症发生率。结果与F组比较,L组第一次插管成功率[54(83.1%)vs 57(86.4%)]差异无统计学意义,第一次插管时间明显延长[(106.9±29.8)s vs(94.6±26.9)s,P0.05];第二次插管成功率[7(63.6%)vs 4(44.4%)]差异无统计学意义,插管时间明显缩短[(107.1±21.5)s vs(137.3±19.5)s,P0.05];插管总成功率[61(92.4%)vs 61(93.8%)]差异无统计学意义。两组患者术后并发症的发生率差异均无统计学意义。结论光棒引导是困难气道患者行经鼻气管插管时的有效技术,可以作为一个应急工具。     

Hemodynamic and bispectral index responses to tracheal intubation during isoflurane or sevoflurane anesthesia

Purpose.The effects of volatile anesthetics on change in the bispectral index (BIS) due to tracheal intubation are unclear. We investigated hemodynamic and BIS responses to intubation during isoflurane or sevoflurane anesthesia. Methods.After obtaining Institutional Review Board approval and informed consent, we randomly allocated 40 patients of American Society of Anesthesiologists (ASA) physical status I to receive either isoflurane (ISO group; n = 20) or sevoflurane (SEV group; n = 20). The patients were anesthetized with thiamylal and were ventilated with 100% oxygen, using a mask. The inspired concentrations of isoflurane and sevoflurane were gradually increased and maintained at end-tidal anesthetic concentrations of 2 minimum alveolar concentration (MAC) during the study period. Tracheal intubation was performed 15min after the end-tidal anesthetic concentrations had reached 2 MAC. Mean arterial pressure (MAP), heart rate (HR), and BIS were recorded before induction, at the loss of consciousness, before laryngoscopy, and at 1, 3, and 5min after intubation. Results.Anesthesia with 2 MAC volatile anesthetics increased HR in the ISO group, and decreased MAP in the SEV group. The BIS value decreased from 95 ± 3 and 96 ± 2 before thiamylal to 39 ± 9 and 38 ± 10 before intubation in the ISO and SEV groups, respectively. MAP and HR were significantly increased in both groups 1 and 3min after intubation, but BIS remained unchanged. Conclusion.Anesthesia with 2 MAC of isoflurane and sevoflurane was effective to suppress the change in BIS due to intubation but was not sufficient to prevent changes in hemodynamic responses.     

光棒辅助与普通喉镜气管插管用于颈椎骨折手术患者的比较

目的比较光棒辅助与普通喉镜气管插管用于颈椎骨折全麻患者的插管效果和安全性。方法选择拟行气管插管全麻的颈椎骨折手术患者40例,男28例,女12例,年龄18~65岁,ASAⅡ或Ⅲ级,随机分为两组,每组20例。全麻诱导后,L组采用光棒引导气管插管,C组采用普通喉镜辅助气管插管。记录一次插管成功例数、插管时间,插管前5 min、插管即刻和插管后5 min的MAP和HR,以及插管时不良反应情况。结果 L组的一次性插管成功率明显高于C组(90%vs.60%),插管时间明显短于C组[(31.3±11.1)s vs.(46.6±15.2)s](P0.05)。与C组比较,L组患者插管期间MAP和HR变化更平稳。C组有4例(20%)心律失常,L组无一例心律失常。结论与普通喉镜比较,光棒引导气管插管用于颈椎骨折手术患者插管更容易,安全性更好。     

Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation

We compared the effects of the lightwand technique on circulatory responses to tracheal intubation with those of direct-vision laryngoscopy. Forty adult patients received propofol and vecuronium, and their lungs were ventilated for 2 min via a mask with 5% sevoflurane in oxygen, after which the trachea was intubated orally using either the lightwand (Trachlight, n = 20) or the Macintosh laryngoscope (n = 20). Maximum mean arterial pressure changes did not differ between groups during (lightwand group, 25 (SD 21) mm Hg vs laryngoscopy group, 23 (19) mm Hg) and after (21 (24) mm Hg vs 21 (16) mm Hg) tracheal intubation. Maximum heart rate changes were similar for groups during (16 (14) beat min-1 vs 16 (15) beat min-1) and after (2 (11) beat min-1 vs 7 (19) beat min-1) tracheal intubation. There were no differences between the lightwand technique and direct-vision laryngoscopy in changes in mean arterial pressure and heart rate during and after tracheal intubation. We conclude that the effects of the lightwand technique on circulatory responses to tracheal intubation were similar to those of direct-vision laryngoscopy.      

老年高血压病人麻醉诱导期的心血管功能变化

目的 通过监测心率、心率变异性(HRV)、血压和心排血量(CO)的变化，探讨术前用降压药的老年高血压病人麻醉诱导期的心血管功能变化规律。方法 40例老年高血压病人分为两组：Ⅰ组，长期应用抗高血压药物组；Ⅱ组，对照组。以咪唑安定、丙泊酚、芬太尼和维库滇铵行麻醉诱导和气管插管。监测诱导期间HR、HRV、MAP和CO的变化。结果 诱导后HR、MAP、CO显著降低，插管即刻及插管后1—3min MAP、HR较诱导后显著升高，插管后5—10min又降至诱导后水平，CO无显著变化。组间比较，Ⅱ组MAP升高幅度显著大于Ⅰ组。LF、HF在诱导及插管后均有了下降趋势，LF/HF无明显改变，组间无显著差异。麻醉诱导后低血压和诱导后15min内麻黄碱用量及输液量无显著差异。结论 老年高血压病人麻醉诱导期间心血管反应明显。术前应用抗高血压药物，选择咪唑安定、丙泊酚、芬太尼和维库滇铵的麻醉诱导气管插管时的心血管反应较未正规用抗高血压治疗的病人轻，对心率变异性无影响；但应注意麻醉诱导前必须补足血容量，以防止发生诱导后低血压。     

Hemodynamic and catecholamine response to a rapid increase in isoflurane or sevoflurane concentration during a maintenance phase of anesthesia in humans

Purpose The purpose of this study was to compare hemodynamic and catecholamine changes due to a sudden increase in inhalation anesthetic concentrations (isoflurane and sevoflurane) during surgery.Methods Thirty patients aged 40–70 years scheduled for lower abdominal surgery were anesthetized with either isoflurane or sevoflurane with nitrous oxide and epidural block. During surgery the isoflurane or sevoflurane concentration was kept at 0.5 minimum alveolar concentration (MAC) (end-tidal concentration) for 15 min. Then the isoflurane or sevoflurane concentration (inhalation concentration) was changed to 1.5 MAC and maintained at that level for 10 min. Thereafter, it was decreased to 0.5 MAC for 10 min. Blood pressure, heart rate, and plasma concentrations of epinephrine and norepinephrine were measured.Results The blood pressure decreased significantly in both groups after increasing the anesthetic concentration, and it increased after decreasing the concentration. The decrease in systolic blood pressure was significantly larger in the isoflurane group. The heart rate increased significantly after increasing the anesthetic concentration only in the isoflurane group. Plasma concentrations of epinephrine and norepinephrine increased significantly in the isoflurane group, whereas the epinephrine concentration (but not the norepinephrine concentration) decreased in the sevoflurane group.Conclusion During surgery a sudden increase in isoflurane concentration induced larger changes in hemodynamics and sympathetic nerve activity than sevoflurane.     

Effects of double administration of nicardipine of the cardiovascular response to tracheal intubation in hypertensive patients

The efficacy of intravenous nicardipine in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation was studied in 20 hypertensive patients. Ten patients received intravenous 1 mg of nicardipine 1 min before induction (N1 group). The other ten received 1 mg of nicardipine 1 min before induction and an additional 1 mg just before laryngoscopy (N2 group). In the N1 group, arterial pressure and heart rate increased significantly after tracheal intubation. In the N2 group, arterial pressure did not increase but heart rate increased more than that in N1 group. There was no significant difference in rate pressure product between the two groups.     

Changes in coagulation and fibrinolytic activity associated with tracheal intubation

This study was carried out to clarify the effect of tracheal intubation on the coagulation and fibrinolytic system. It was performed on 20 patients (ASA class 1–2) undergoing elective surgery. Before and after tracheal intubation, hemodynamics, ACTH, cortisol, catecholamines, and several coagulation and fibrinolytic factors were measured. Tracheal intubation was accompanied by significant increases in the blood pressure, heart rate, and norepinephrine level. No changes were observed in fibrinopetide A, fibrinopeptide B_15–42, tissue plasminogen activator antigen, plasminogen, fibrinogen, and ₂ plasmin inhibitor. Patients exposed to long intubation time (20 seconds) were found to have a significantly higher level of fibrinopeptide A than patients with short tracheal intubation time (20 seconds) (P 0.05). It therefore can be concluded that the increase in norepinephrine and changes in the hemodynamics following tracheal intubation have no impact on the coagulation and fibrinolytic activity. Also, if the duration of intubation is prolonged, thrombin activity may be promoted.(Gando S, Tedo I, Kubota M, et al.: changes in coagulation and fibrinolytic activity associated with tracheal intubation. J Anesth 6: 80–84, 1994)     

Hemodynamic and catecholamine responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injuries

BACKGROUND: Endotracheal intubation in patients undergoing general anesthesia often causes hypertension and tachycardia, which may be altered when the efferent sympathetic fiber to the cardiovascular system is interrupted. The aim of the current study was to investigate the effects of different levels of spinal cord injury on the cardiovascular responses to intubation. METHODS: Fifty-four patients with traumatic complete cord injuries requiring tracheal intubation were grouped into quadriplegics (above C7; n = 22), high paraplegics (T1-T4, n = 8), and low paraplegics (below T5, n = 24) according to the level of injury. Twenty patients without spinal injury served as controls. Arterial pressure, heart rate, and rhythm were recorded at intervals for up to 5 min after intubation. Plasma concentrations of catecholamines were also measured. RESULTS: The intubation increased the systolic blood pressure similarly in control, high-paraplegic, and low-paraplegic groups (P < 0.05), whereas it did not alter the blood pressure in the quadriplegic group. Heart rate was significantly increased in all groups; however, the magnitude was more pronounced in the high-paraplegic group (67%) than in the control (38%) and quadriplegic (33%) groups. Plasma concentrations of norepinephrine were significantly increased after intubation in all groups; however, values were lower in the quadriplegic group and higher in the low-paraplegic group compared with those in the control group. Incidence of arrhythmias did not differ among groups. CONCLUSIONS: The cardiovascular and plasma catecholamine changes associated with endotracheal intubation may differ according to the affected level in patients with complete spinal cord injuries.     

舒芬太尼对老年患者诱导期丙泊酚抑制气管插管反应半数有效血浆浓度的影响

目的 探讨不同靶浓度的舒芬太尼复合丙泊酚靶控输注(targeted-controlled infusion,TCI)抑制气管插管反应的丙泊酚半数有效血浆浓度(the median effective plasma concentration,Cp50).方法 研究对象为94例择期全麻拟行气管插管手术患者,ASA Ⅰ～Ⅲ级,年龄在60岁～79岁.根据年龄段和舒芬太尼靶浓度的不同按随机数字表法分为4组,A组为60岁～69岁、0.2 μg/L;B组为60岁～69岁、0.3 μg/L;C组为70岁～79岁、0.2 μg/L;D组为70岁～79岁、0.3 μg/L.试验以效应室浓度TCI舒芬太尼,待舒芬太尼血浆浓度与效应室浓度平衡后,以血浆靶浓度TCI丙泊酚,意识消失后给予0.2 mg/kg的顺阿曲库铵,待丙泊酚的血浆浓度和效应室浓度平衡且静注顺阿曲库铵达3 min后行气管插管.丙泊酚的血浆靶浓度按序贯法确定.结果 A组患者有效抑制气管插管反应的丙泊酚的Cp50为3.60 mg/L,95％可信区间(confidence interval,CI)为3.44 mgl～3.76 mg/L;B组患者Cp50为2.03 mg/L,95％CI为1.88 mg/L～2.20 mg/L;C组患者Cp50为2.70 mg/L,95％CI为2.56 mg/L～2.84 mg/L;D组患者Cp50为1.97 mg/L,95％CI为1.81 mg/L～2.12 mg/L.结论 随着舒芬太尼的效应室靶浓度的增加以及年龄的增加,丙泊酚的Cp50明显降低.     

右美托咪啶预防全麻气管插管和拔管心血管反应的临床观察

目的 观察右美托咪啶预防全身麻醉气管插管和拔管过程中心血管反应的临床效果。方法 选择30例拟在全身麻醉下行择期腹部手术的患者（ASAⅠ～Ⅱ级）,随机分为2组：对照组（C组）和右美托咪啶组（D组）,每组15例。D组全麻诱导前静脉泵注右美托咪啶1ug/kg,15min泵注完;C组则静脉泵注等量的生理盐水。两组诱导用药均为丙泊酚1.5mg/kg,芬太尼3μg/kg及顺式阿曲库铵0.2mg/kg。记录并比较下列各时间点两组患者的平均动脉压（MAP）、心率（HR）、心率收缩压乘积（RPP）的变化：①注药前（基础值）,DEX或生理盐水输注后5、10、15min;②插管前1min,插管即刻,插管后1、3、5min;③拔管前5min,拔管即刻,拔管后3、5、10min。记录两组插管和拔管期间RPP＞12000的发生情况。结果 D组注药后10、15、插管前1min的HR较基础值下降（P＜0.05）。D组插管即刻、插管后1min、拔管时的MAP和HR均明显低于C组（P＜0.05）。注药后15min至拔管后各时间点D组患者的RPP均低于C组（P＜0.05）。D组在插管和拔管期间RPP＞12000的发生率明显小于C组（P＜0.05）。两组患者的苏醒时间、拔管时间和Ramsay评分比较差异无统计学意义。结论 右美托咪啶能显著减轻气管插管和拔管时的心血管反应,维持血流动力学的稳定,同时对麻醉恢复期没有影响。     

GlideScope视频喉镜在颈椎活动受限患者气管插管中的应用体会

目的 介绍新型插管工具GlideScope视频喉镜在颈椎活动受限患者插管中的应用.方法 84例择期或急诊颈椎手术患者,ASAI～II级,术前存在颈椎外伤或严重的颈椎病,在快速静脉全麻诱导后先用Macintosh喉镜暴露声门进行Comack评级,然后运用视频喉镜进行插管,记录插管操作时间、次数和并发症,并测量诱导前(T_1)、诱导后(T_2)、插管时(T_3)、插管后1min(T_4)、气管插管后3 min(T_5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP).结果 GlideScope视频下Cor-mack分级显著改善(P<0.05),插管成功率为970.6%,插管时间为12 s~135 s,平均为(28.7±9.2)s.78例患者1次插管成功;4例患者2次插管成功;另有2例患者改为纤支镜插管;82例患者在气管插管过程中HR、SBP、DBP、ABP平稳,插管未造成呼吸道损伤.结论 GlideScope视频喉镜插管适合颈椎活动受限的困难气道,成功率高、插管迅速、安全性好.     

Plasma catecholamine response to tracheal intubation after midazolam and vecuronium in elderly patients with hypertension

This study was undertaken to determine whether midazolam alleviates sympathoadrenal response evoked by tracheal intubation in elderly patients with hypertension. Anesthesia was induced with midazolam in a sleep dose followed by vecuronium 0.1 mg.kg-1. Heart rate and blood pressure were recorded before, 1 and 3 minutes after induction with intubation. Free and total catecholamine (CA) in plasma were measured at each time. Dopamine, norepinephrine and epinephrine (EN) were determined using fluorescence derivatization with diphenylethylenediamine by HPLC. Although heart rate and diastolic pressure rose in some degree 1 min after intubation, free and total CA concentrations did not increase during study period. Free and total EN levels decreased significantly 3 min after intubation. The absence of elevation in plasma CA concentrations, especially in free CA, which is physiologically active, would contribute to produce circulatory stability on laryngoscopy and tracheal intubation. However, the mystery of why hyperdynamic state was produced without the increase in CA concentrations remains to be solved, even though it occurred for a short period of time.     

Hemodynamic and catecholamine responses to laryngoscopy with vs. without endotracheal intubation

To study the relationship between the intensity of the stimulus exerted against the base of the tongue during direct laryngoscopy and the magnitude of associated hemodynamic and catecholamine responses, a study was conducted in 40 ASA I or II patients. Laryngoscopy lasting 40 s was performed with a size 3 Macintosh blade connected to a force-displacement transducer. The intensity of the stimulus exerted during laryngoscopy is expressed by the product of its average force (N) and duration (s) and given as impulse in Ns. Highly significant relationships were found between the impulse during laryngoscopy and the maximal hemodynamic and catecholamine responses. Also, when laryngoscopy was followed by orotracheal intubation, significant relationships were found with steeper slopes of the regression lines for systolic blood pressure, heart rate and plasma epinephrine concentrations. A more rapid regression of hemodynamic data was seen in intubated patients, whereas their plasma catecholamine concentrations regressed more slowly. The mechanisms of the responses to laryngoscopy and orotracheal intubation are proposed to be by somato-visceral reflexes. Stimulation of proprioceptors at the base of the tongue during laryngoscopy induces impulse-dependent increases of systemic blood pressure, heart rate and plasma catecholamine concentrations. Subsequent orotracheal intubation recruits additional receptors that elicit augmented hemodynamic and epinephrine responses as well as some vagal inhibition of the heart.     

三种喉镜对老年患者气管插管应激反应的影响

目的探讨直接喉镜、视频喉镜、SOS喉镜对老年患者麻醉诱导心率变异性(HRV)及血流动力学的影响。方法拟行全麻手术气管插管的老年患者90例,ASAⅠ或Ⅱ级、BMI 18~24kg/m2,年龄65~80岁,随机均分为直接喉镜组(M组)、视频喉镜组(G组)和SOS喉镜组(S组)。三组患者采用相同的全身麻醉诱导方法,分别记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)的SBP、DBP、HR及各时点的HRV频域分析指标:低频(LF)、高频(HF)、标化的LF(LFnu)、标化的HF(HFnu)、LF/HF,并记录三组插管时间和插管引起的并发症。结果与T0时比较,T1、T4、T5时三组患者SBP、DBP明显降低(P0.05或P0.01);T2、T3时M组,T2时G组HR明显增快(P0.01)。与M组比较,T2时S组HR明显减慢(P0.01)。三组患者不同时点HRV、LF、LFnu、HF、HFnu差异无统计学意义;与T0时比较,T2~T4时M组和G组LF/HF明显升高(P0.05);与M组比较,T2、T3时S组LF/HF明显降低(P0.05)。S组的插管时间明显短于M组(P0.01);术后随访M组1例牙齿脱落、2例咽痛、1例声嘶,G组3例咽痛、1例声嘶,S组1例咽痛。结论直接喉镜、视频喉镜、SOS喉镜均可用于老年患者气管插管,但SOS喉镜更适用于老年患者。     

听觉诱发电位指数用于诱导插管期间麻醉深度监测的临床评价

目的 观察听觉诱发电位指数在全麻诱导插管期间的变化，评价其用于临床麻醉深度监测的有效性。方法 ASAⅠ-Ⅱ级，全麻下行择期手术的病人40例。依次给予咪唑安定0.06mg/kg，芬太尼4μg/kg，丙泊酚0.5mg/kg，维库溴铵0.1mg/kg诱导后，行气管插管，观察诱导前，气管插管前，插管时及插管后1-5分钟等8个时点的AEPI，BIS，HRV，SEF及MAP，HR和RPP的变化。结果 诱导后各观察指标较诱导前的基础值均有所降低，插管后BIS，HRV，SEF等指标均在5分钟内回复至插管前水平，AEP在第3分钟即可回复至插管前水平，插管前后几项观察指标变化趋势相一致。结论 AEPI，BIS，HRV，SEF均能有效反映插管的应激反应。AEPI较其他几项指标更为迅速灵敏，可作为麻醉深度监测的有效指标。     

Use of the laryngeal mask for fibrescope–aided tracheal intubation in an awake patient with a deviated larynx

I report a case in which fibrescope–aided awake tracheal intubation was achieved using a laryngeal mask, in a patient with a mediastinal goitre in whom tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope had failed. The tumour extended to the upper part of the mediastinum. The larynx and the upper segment of the trachea were displaced by the tumour. Awake tracheal intubation with both a laryngoscope and a fibreoptic bronchoscope failed. The laryngeal mask was then inserted without difficulty. After a fibreoptic bronchoscope had been covered by a plastic tube, the combination was passed through the laryngeal mask into the trachea. The fibreoptic bronchoscope and the laryngeal mask were removed, and a reinforced endotracheal tube was then inserted over the plastic tube into the trachea. The time for tracheal intubation was about 70 s. The laryngeal mask may allow easier location of the laryngeal inlet with a fibreoptic bronchoscope, and this technique is a useful alternative to the conventional technique of tracheal intubation in the patient with a deviated larynx.