Fiberoptic Scope Research Articles

Successful emergency management of hemorrhagic shock due to carotid artery aneurysm: the role of awake intubation in difficult airway control

We describe the clinical scenario, analyze the decision-making process in airway management, and application of the Difficult Airway Society (DAS) guidelines for awake tracheal intubation (ATI) in a patient involving life-threatening bleeding from an internal carotid artery aneurysm caused by a fistula following radiotherapy for tongue cancer at Hong Ngoc Phuc Truong Minh General Hospital, on March, 2024. A 53-year-old male, diagnosed with tongue cancer, underwent surgery. Days before admission, he experienced pain and bleeding from the right lateral neck due to an internal carotid artery aneurysm. An attempt at tracheal intubation for endovascular intervention at another hospital failed. Upon arrival at our emergency department, he exhibited massive neck hemorrhage, remained conscious, pale, with ongoing bleeding from a right neck fistula, and limited cervical motion due to irritation. A treatment strategy for permanent occlusion of the aneurysm was devised. Awake tracheal intubation using a fiberoptic scope via the nasal route was performed. The patient received light sedation with midazolam, and the airway was topicalized with 10% lidocaine spray over the mouth, tongue, and oropharyngeal mucosa. Continuous monitoring of heart rate, ECG, and oxygen saturation showed no decrease in oxygen levels, and the patient maintained spontaneous breathing throughout. Intensive treatment with crystalloid fluids and blood transfusion, along with right internal carotid embolization with a spring coil, effectively prevented massive hemorrhage. The patient was successfully extubated after three days in the ICU and discharged 15 days post-surgery without any neurological deficits. Keywords: Awake Tracheal Intubation; Difficult Airway Management; Fiberoptic Scope; Emergency Airway Management Citation: Ba NTT. Successful emergency management of hemorrhagic shock due to carotid artery aneurysm: the role of awake intubation in difficult airway control. Anaesth. pain intensive care 2024;28(5):955−959. DOI: 10.35975/apic.v28i5.2572 Received: January 03, 2024; Reviewed: May 05, 2024; Accepted: June 11, 2024

Alternative Hybrid Technique of Intubation Using C-MAC and Yankauer Suction Catheter: Case of A Floppy Supraglottic Mass.

Supraglottic masses can be an anaesthesiologist's nightmare due to the difficult airway scenario and bleeding risk during airway manipulation. Awake fibreoptic intubation is the primary method to secure the airway in such cases. However, most practising anaesthesiologists are not experts at handling the fibreoptic scope, especially in cases with a floppy supraglottic mass where it becomes difficult to displace the mask with the thin flexible bronchoscope. A hybrid technique of intubation in supraglottic masses using Bonfils rigid scope and C-MAC is often described but frequently not available. Here we describe a case of an elderly patient in their 80s presenting with a floppy supraglottic mass where an awake fibreoptic bronchoscope failed to secure the airway. Without access to a rigid Bonfils scope, we intuitively used a C-MAC to visualize the larynx and a yankauer suction catheter to displace the mass and perform a bougie-guided endotracheal intubation.

The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit.

A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.

Flexible Fiber-Optic Scope Use in Retrieval Medicine: A Case Series

ObjectiveThe use of flexible fiber-optic scopes is increasing across critical care specialities, but there is limited literature on their use in retrieval medicine. This study aims to describe a case series in which flexible fiber-optic scopes were used by New South Wales Ambulance Aeromedical Operations critical care teams. MethodsA retrospective case series was performed in our service from January 1, 2019, to December 31, 2021. We searched our electronic medical retrieval database for the terms “aScope,” “Awake Fibreoptic Intubation (AFOI),” “Fibreoptic Intubation (FOI),” and “Nasal Endotracheal Tube (ETT)” to identify when a flexible fiber-optic scope was used. ResultsThere were 16 uses of flexible fiber-optic scopes during the study period. The most common procedure was awake nasal fiber-optic intubation, which was performed during 9 cases, 7 of which were successful. Other procedures performed included 4 cases of intubation through a supraglottic airway, 1 case of an asleep fiber-optic intubation, 1 case of flexible nasoendoscopy for upper airway assessment, and 1 case of fiber-optic bronchoscopy via tracheostomy. These procedures were performed by anesthetic, emergency and intensive care doctors. This case series describes 4 of these cases in more detail. ConclusionThis case series demonstrates a variety of procedural and diagnostic uses for flexible fiber-optic scopes in retrieval medicine. These procedures can have an important bearing on decision making and patient management. The training and clinical governance provided by our service in this skill appears to be safe and robust with high success rates of awake fiber-optic intubations.

Throat packing via nasopharyngeal airway for severe trismus cases requiring surgical intervention under general anesthesia: A simplified and innovative approach

Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.

Near-miss Tracheal Stenosis Secondary to Acute Intubation

ABSTRACT Tracheal stenosis is a rare and life-threatening condition. If left undiagnosed, this can lead to failed intubation, surgery postponement, or additional invasive airway management. A high index of suspicion from attending anesthesiologists due to inconsistencies between patient’s symptoms and diagnostics could lead to a more accurate diagnosis and management. This is a case of a 24-year-old female with difficulty breathing who was initially assessed as a case of glottic mass. The dilemma between the patient’s presentation and the preidentified airway obstruction led the anesthesiologist to do further investigation. A quick upper airway evaluation was done using the flexible fiber-optic scope which unexpectedly showed a 70%–80% circumferential subglottic stenosis. Management was henceforth changed to tracheal resection and reconstruction to address this new finding. Meticulous planning, preparation, and transdisciplinary approach of communication with the surgical team alongside detailed knowledge are probably the most important factors in the management of tracheal stenosis.

Study to assess the effectiveness of Kegal Exercise and Prone Position on after pain and Involution of Uterus among Post Natal Mothers at Private Hospital Rajkot

Health is the level of functional or metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social challenges. An individual with healthy body and mind is an asset to the family and society. But health is not a commodity to purchase; health can be destroyed by various disorders or diseases. Disease broadly refers to any condition that impairs the normal functioning of the body. Some minor disease can be treated at home itself, while some major disorder or severe diseases requires medical therapy or surgical treatments in the health care set-up. Clients with critical condition such as upper GI bleeding, masses or tumors, upper GI stricture and sepsis are required to be treated in endoscopy unit of hospital setting. Endoscopy unit is special department of hospital or health care facility that provides visualization through internal organ with help of different fiber optic scopes to the patient with upper GI problems like bleeding, masses, stricture and foreign body ingestion as well as lower GI problems like intestinal obstruction, bleeding and also for patients with respiratory disorders. Close monitoring and support from special equipment and medications to the patients in order to ensure normal bodily functions. Patients undergoing any procedures have mild to severe anxiety towards the procedure. Decreasing or relieving anxiety help the patient and care giver for procedures. There are different ways to decrease anxiety of patients like posters, charts videos and verbal information. The HAM- A tool was used to assess anxiety. HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms and is still widely used today in both clinical and research settings. It is psychological questionnaires used by clinicians to rate the severity of patient’s anxiety. HAM-A developed by M. Hamilton and it is based on 14 parameters including anxious mood, tension, fears, insomnia, somatic complaints and behavior.

Cost-Effectiveness Analysis of PET-CT Surveillance After Treatment of Human Papillomavirus-Positive Oropharyngeal Cancer.

To determine the cost-effectiveness of surveillance imaging with PET/CT scan among patients with human papillomavirus-positive oropharyngeal squamous cell carcinoma. Cost-effectiveness analysis. Oncologic care centers in the United States with head and neck oncologic surgeons and physicians. We compared the cost-effectiveness of 2 posttreatment surveillance strategies: clinical surveillance with the addition of PET/CT scan versus clinical surveillance alone in human papillomavirus-positive oropharyngeal squamous cell carcinoma patients. We constructed a Markov decision model which was analyzed from a third-party payer's perspective using 1-year Markov cycles and a 30-year time horizon. Values for transition probabilities, costs, health care utilities, and their studied ranges were derived from the literature. The incremental cost-effectiveness ratio for PET/CT with clinical surveillance versus clinical surveillance alone was $89,850 per quality-adjusted life year gained. Flexible fiberoptic scope exams during clinical surveillance would have to be over 51% sensitive or PET/CT scan cost would have to exceed $1678 for clinical surveillance alone to be more cost-effective. The willingness-to-pay threshold at which imaging surveillance was equally cost-effective to clinical surveillance was approximately $80,000/QALY. Despite lower recurrence rates of human papillomavirus-positive oropharyngeal cancer, a single PET/CT scan within 6 months after primary treatment remains a cost-effective tool for routine surveillance when its cost does not exceed $1678. The cost-effectiveness of this strategy is also dependent on the clinical surveillance sensitivity (flexible fiberoptic pharyngoscopy), and willingness-to-pay thresholds which vary by country.

The difference in rotation angle of the distal endotracheal tube through nasal approach

BackgroundNasal intubation using a fiberoptic scope is a useful technique. In clinical practice, we have experienced difficulty in advancing the endotracheal tube (ETT) over the fiberoptic scope because of resistance to the passage of the ETT against rotation in the nasal cavity, when it gets hung up on structures of the laryngeal inlet. Several maneuvers have been proposed to overcome this difficulty. The gap between the tip of the ETT and the fiberoptic scope can be reduced using a thicker fiberoptic scope and a thinner ETT. Moreover, simultaneous rotation of the fiberoptic scope and ETT could lead to successful intubation by reducing impingement on the ETT. However, the discrepancy between these rotation angles is unclear. This observational prospective study aimed to investigate the discrepancy in the rotation angle between the ETT and fiberoptic scope during nasal intubation.MethodsThe patients (aged 20–80 years) who underwent nasal intubation for oral and maxillofacial surgery participated in three sizes of preformed nasal ETT and were intubated using a fiberoptic scope. They were divided into three groups; the ETT internal diameter (ID) 6.5 mm (6.5 group), ID 7.0 mm (7.0 group), and ID 7.5 mm (7.5 group). The ETT was then inserted through the nasal cavity into the pharynx. After the fiberoptic scope was advanced through the ETT above the glottis, simultaneous rotation by both the proximal end of the fiberoptic scope and ETT was performed in 90° and 180° in both right (clockwise) and left (counterclockwise) directions, and the rotation angle at the distal end of the ETT was monitored using a video laryngoscope (Pentax-AWS).ResultsA total of 39 patients were included in the study. When both the proximal end of the fiberscope and ETT were simultaneously rotated by 90°, in the 6.5 group (n = 13), the distal end of the ETT rotated by 47.8 ± 1.5°. In the 7.0 °group (n = 13), the distal end of the ETT rotated by 45.5 ± 1.0°. In the 7.5 group (n = 13), the distal end of the ETT rotated by 39.9 ± 1.0°. When the proximal end of the fiberscope and ETT were rotated by 180°, in the 6.5 group, the distal end of the ETT rotated by 166.2 ± 2.5°. In the 7.0 group, the distal end of the ETT rotated by 145.7 ± 2.2°. In the 7.5 group, the distal end of the ETT rotated by 115.1 ± 2.0°. All rotation angles in the distal end of the ETT were significantly lower than those in both the proximal end of the fiberscope and ETT (p < 0.05). Rotating right by 180° was significantly different among the three groups (p < 0.05), although rotating right by 90° was not significantly different. Similar results were obtained for the left rotation.ConclusionSimultaneous rotation by the proximal end of the ETT and fiberscope above the glottis for the nasal approach induced significant differences in the distal end of the ETT. The larger tube lagged by the resistance of the nasal passages during rotation. Therefore, the ETT does not rotate as much as the rotation angle.Trial registrationThis prospective observational study was conducted after receiving approval from the Ethics Review Board of Kyushu University Hospital (Approval No. 30–447).

Randomized Clinical Trial Comparing the Success Rate of Blockbuster Intubating Laryngeal Mask Airway Versus Fastrach Intubating Laryngeal Mask Airway During Blind Endotracheal Intubation.

Background A new piece of equipment, the Blockbuster (BB) Intubating Laryngeal Mask Airway (ILMA; Tuoren MedicalIndia, Gurugram, India), was created in 2012. Dr. Chandy created the Fastrach (F) ILMA in 1997, which is another supraglottic airway equipment. The primary purpose of this study was to compare the success rateof intubation with BB-ILMA and F-ILMA. Methods In the chosen age category of >20 to <70 years, undergoing general anesthesia for intubation with ILMAs, 55 patients were in the BB-ILMA(group B), and 55 patients were in the F-ILMA (group F). These ILMAs were put in after the induction and checked to see if adequate ventilation was accomplished with either of these devices. Once ventilation had been attained, weproceeded with fiberoptic scope to visualize the glottis, followed by blind intubation. The primary objective was to compare the first pass successful intubation of BB-ILMA and F-ILMA. The secondary objectives were ease of LMA insertion, time taken for intubation, hemodynamic changes, glottis fiberoptic view, and complications. Results The first pass successful intubation of the BB-ILMA and F-ILMA are 94.5% and87.3%, respectively, whereas thetime taken for intubation in BB-ILMA and F-ILMA are 25.02 seconds (s) and42.77 s with ap-value of 0.0001, indicating a statistically significant relationship. Conclusion When compared to the F-ILMA (group F), the BB-ILMA (group B) has a higher success rate for blind tracheal intubation, with lesser time taken for intubation and fewer complications.

Awake Fiberoptic Intubation

We may have many devices in this 21st century, which can be used to secure the airway in patients who have been predicted to have a difficult airway. There are many studies about difficult airways and suggested various devices such as flexible fiberoptic scope, video laryngoscope, and the specialized intubating laryngeal mask airway and they ended up concluding one device better than another. Furthermore, ET intubation requires continued practice and carries with it its own set of complications. Technical problems with the placement of endotracheal tubes have been the most frequent cause of anesthetic deaths in published analyses from all over the world. The basic responsibility of an anesthesiologist is to maintain adequate gas exchange in patients by securing a patent airway through a proper device. Fiberoptic bronchoscopy and intubation have the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure, especially in the case of children. We report two such cases, where “Awake flexible fiberoptic-guided intubation” was considered the only desirable choice.

Tracheo-oesophageal fistula - A disastrous complication of endotracheal intubation!

A 28-year old man required invasive mechanical ventilation in view of organophosphorus poisoning in a peripheral hospital. His trachea was extubated ten days later following which he presented with dysphagia, voice change, burping, fever and cough. He was referred to our hospital for further management. His barium swallow radiograph showed a large tracheo-oesophageal fistula. Therefore, he was scheduled for oesophageal transection and colonic transposition. Following induction of anaesthesia, despite easy laryngoscopy view (Cormack Lehane grade 1), the tracheal intubation was found to be difficult as the tube tended to pass through the fistula into the oesophagus repeatedly as confirmed by absence of capnogram trace. Attempts to bypass the fistula using a fibreoptic scope and even a double lumen tube also failed. Identification of oesophageal intubation would have been missed or possibly detected late in this case with disastrous consequences but for absence of capnogram. Finally, the tracheal tube was successfully negotiated beyond the fistula with the help of a gum elastic bougie directed anteriorly into the trachea and a good capnogram was obtained. The surgery was uneventful and the trachea was extubated 24 h later in the intensive care unit following which the patient developed stridor requiring permanent tracheostomy. This case report illustrates the novel use for gum elastic bougie during tracheal intubation. This also highlights the importance of repeated measurement of tracheal cuff pressure in patients especially those receiving long duration mechanical ventilation.

Two Airway Management Techniques in a Pediatric Patient with Temporomandibular Joint Ankylosis: Two-stage Fiberoptic Scope Intubation Technique and Video Laryngoscope-guided Conversion from Nasotracheal to Orotracheal Intubation — A Case Report

Ankyloblepharon-ectodermal dysplasia-clefting (AEC) syndrome is an ectodermal dysplasia presenting with cleft lip or palate and congenital filiform eyelid fusion. This is a case report of a 1-year and 6-month-old girl with AEC syndrome presenting with temporomandibular joint ankylosis who underwent release of temporomandibular joint ankylosis, coronoidectomy, bilateral cheiloplasty, Tajima rhinoplasty, and repair of lower lip pits under general anesthesia. Fiberoptic nasotracheal intubation was done successfully using a two-stage technique originally described by Stiles. As necessitated by the surgical plan, video laryngoscope guidance was subsequently used to facilitate the conversion from nasotracheal to orotracheal intubation.

Diagnostic role of fiberoptic bronchoscopy in various respiratory diseases at esic medical college hospital Sanath Nagar

Background: Fiber-optic bronchoscopy is a safe and effective diagnostic and therapeutic technique for pulmonary disease diagnosis and treatment. The purpose of this descriptive study was to determine the demographic profiles, indications, bronchoscopic findings, and diagnosis of individuals who had a bronchoscopic examination. Materials and Methods: For a year, 150 patients received bronchoscopies at the ESICMCH hospital in Sanath Nagar, Hyderabad, in the department of pulmonary medicine. All of the subjects underwent a thorough clinical history, physical examination, and standard tests. Sputum examination (for acid fast bacilli (AFB) staining, gramme staining, culture/sensitivity, KOH staining, malignant cells), hematological examination, and coagulation profile were performed on all patients. Fiberoptic bronchoscopy was then performed on all of the patients. Under topical anesthetic (2% lignocaine), flexible bronchoscopy was done with a fiberoptic scope via the transnasal route. Pulse oximetry was used to measure oxygenation throughout the process. After a thorough inspection of the endobronchial tree, appropriate samples such as bronchoscopic aspirate, brushing, and biopsy were taken, depending on the lesion. Depending on the clinical diagnosis and bronchoscopic findings, samples were submitted to cytology and histology. Results: Out of 150 patients, 100 (66.67%) were males and 50 (33.33%) were females.

Risk Factors for Postoperative Sore Throat After Nasotracheal Intubation.

Postoperative sore throat is relatively frequent complication after orotracheal intubation. However, there are few reports about postoperative sore throat in nasotracheal intubation. In this retrospective study, we investigated the risk factors of postoperative sore throat in nasotracheal intubation. Anesthesia records of patients 16 to 80 years of age who underwent nasotracheal intubation were included. Patients underwent oral and maxillofacial surgery from February 2015 until September 2018. Airway device (Macintosh laryngoscope, Pentax-AWS, or McGRATH video laryngoscope, or fiberoptic scope), sex, age, height, weight, American Society of Anesthesiologists classification, intubation attempts, duration of intubation, intubation time, tube size, and fentanyl and remifentanil dose were investigated. Fisher exact test, Wilcoxon rank sum test, Welch t test, and Steel-Dwass multiple test were used, and a multivariable analysis was performed using stepwise logistic regression to determine the risk factors of postoperative sore throat. A total of 169 cases were analyzed, and 126 patients (74.6%) had a postoperative sore throat. Based on the univariate analysis of the data, 12 factors were determined to be potentially related to the occurrence of a postoperative sore throat. However, after evaluation using stepwise logistic regression analysis, the 2 remaining variables that correlated with postoperative sore throat were airway device (P &lt; .05) and intubation attempts (P = .04). In the model using logistic regression analysis, the fiberoptic scope had the strongest influence on the incidence of sore throat with reference to Pentax-AWS (odds ratio = 5.25; 95% CI = 1.54-17.92; P &lt; .05). Use of a fiberoptic scope was identified as an independent risk factor for postoperative throat discomfort. Compared with direct laryngoscopy and other video laryngoscopes, the use of a fiberoptic scope had a significantly higher incidence of sore throat.

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report

Evaluation of ACE-inhibitor Induced Laryngeal Edema Using Fiberoptic Scope: A Case Report.

ACE-I, angioedema, fiberoptic laryngoscope, laryngeal edema, tranexamic acid.

Alternative Technique for Nasotracheal Intubation Using a Flexible Fiberoptic Scope.

In oral maxillofacial surgery, the endotracheal tube (ETT) is often inserted nasotracheally to provide surgeons a better view and easier access to the oral cavity. Use of a flexible fiberoptic scope is an effective technique for difficult intubation. While the airway anatomy can be observed as the scope is advanced, the ETT tip cannot be observed with the traditional method. It is occasionally difficult to advance the ETT beyond the glottis as impingement of the ETT tip may occur. We devised a new nasotracheal intubation technique using a fiberoptic scope. In this novel technique, the ETT and fiberoptic scope are inserted into the pharyngeal space separately through the right and left nasal cavities. This permits continuous observation of the glottis as the ETT is advanced into the trachea. The main advantage of this technique is that the ETT tip is visualized as it is advanced, which helps avoid impingement of the ETT. If resistance is noted, the ETT can easily be rotated or withdrawn without causing laryngeal damage, leading to safe and smooth intubation. This novel technique allows advancement of the ETT under continuous indirect vision, thus minimizing contact of the ETT with the laryngeal structures and aiding in unhindered passage into the glottis.

Migration of a Fish Bone From the Esophagus to the Thyroid Gland.

Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3years of follow-up.

Retromolar intubation with video intubating stylet in difficult airway: A randomized crossover manikin study

ObjectiveDifficult airway situations, such as trismus and neck rigidity, may prohibit standard midline orotracheal intubation. An alternative route of intubation from the retromolar space using a fiberoptic scope or rigid intubation stylet has been reported. There is no study investigating the applicability of retromolar intubation using a video intubating stylet. This study comparatively analyzed difficult airway management using a video intubating stylet in the retromolar and standard midline approaches. MethodsA randomized crossover manikin study was conducted between January 2021 and June 2021 at a tertiary teaching hospital. Thirty-six emergency medicine residents and attending physicians were enrolled, and all participated in an educational course regarding video intubating stylet in standard midline and retromolar approaches. Then, they performed both intubation approaches in a randomized order on a manikin seven times with different airway settings each time. The duration of successful intubation, first attempt success rate, overall success rate, number of attempts, and self-reported difficulty were recorded and compared. ResultsThirty-six emergency physicians were included in the study. Compared with the standard midline approach, the use of the retromolar approach significantly reduced the duration of successful intubation in difficult airway scenarios such as limited mouth opening and neck rigidity with (44.77 [28.58–63.65] vs. 120 [93.86–120] s, p < 0.001) and without tongue edema (31.5 [22.57–57.74] vs. 44.72 [36.23–65.34] s, p = 0.012). Furthermore, the retromolar approach increased the first attempt success rate in scenarios of limited mouth opening and neck rigidity with (91.67% vs. 16.67%, p < 0.001) and without (97.22% vs. 72.22%, p = 0.012) tongue edema. The self-reported difficulty was also significantly lower with the retromolar approach than with the standard approach in the above two scenarios. ConclusionsThe retromolar approach for intubation using a video intubating stylet may be a promising choice for selected patients with a combination of difficult airway features such as limited mouth opening, neck rigidity, and edematous tongue.