Orotracheal intubation guided with a vivasight single lumen tube in unanticipated difficult airway

Abstract

Introduction The management of an unanticipated difficult airway is a challenge for any anesthesiologist. Over the years, devices have been developed to improve intubation in cases of difficulty. Methods We present the case of a patient with an unanticipated difficult airway, who was intubated during the first attempt thanks to the use of a VivaSight tube. The consent for the publication of this case was obtained by the patient. He is a 57-year-old man, who underwent a programmed left upper lobectomy. Predictors of airway assessment performed in preanesthesia classified the patient as low risk. The initial plan included the use of a VivaSight SL tube and a bronchial blocker for left lung collapse under direct vision during surgery. Results The patient underwent general anesthesia. After 2 minutes of induction and verify that the ventilation could be carried out without problem, a direct laryngoscopy was performed. A spheroidal tumor adhered to the epiglottis was visualized (figure 1), turning the patient into a Cormack-Lehane III grade. Because we had prepared a VivaSight single lumen endotracheal tube for intubation, we chose to perform intubation guided by the video of the camera integrated in the VivaSight tube. The intubation sequence can be seen in the images of figure 1. The result was an intubation of less than a minute in duration and without incidents during the first attempt. Discussion VivaSight is a special tracheal tube, which has a built-in direct vision camera. It is used mostly in anesthesia for thoracic surgery. There are 2 models: double lumen and single lumen. The single lumen can usually be used together with bronchial blockers without requiring a fiber optic bronchoscope. The main advantages described with the use of these devices are the visualization of the correct position of the tube and the visualization of the correct position of the bronchial blocker2. Other authors have shown that the use of the VivaSight tube decreases intubation time and number of attempts with respect to video laryngoscopy in emergencies3. In the case that we have described, the camera of the tube allowed us to perform an intubation in a case of unanticipated difficult airway. Therefore, we think that the VivaSight tube should be an option to consider in the cases of patients with anticipated or known difficult airway in thoracic surgery. However, it is necessary to develop prospective studies that provide more evidence.