A bronchial fiberscope (BFS) is an endotracheal intubation device for obtaining a clear view of various intubation devices in difficult intubation situations. However, intubation can still be difficult even if a BFS is used, and various additional intubation aids may be required. We report a patient with cervical kyphosis in whom the insertion of a BFS into the trachea was difficult despite a clear view of the glottis.
A 24-year-old man with autism, mental retardation, and severe head anteflexion resulting from cervical kyphosis was scheduled to undergo dental treatment under general anesthesia. During tracheal intubation, the patient’s glottis could not be visualized using either a GrideScope® or a McGRATHTM because of a narrow oral cavity caused by trismus and impaired anterior sliding of the mandibles. We used a BFS and obtained a clear view of the glottis but were unable to advance the tip of the BFS to the glottis because of the large distance between the glottis and the BFS tip. We then used a Deschamps needle inserted into the oral cavity to change the direction of the intubation tube and succeeded in achieving tracheal intubation. Deschamps needles are instruments that were originally used in ophthalmic surgery. We believe that Deschamps needles could be useful instruments during intubation, especially in cases with narrow oral cavities.
