[Intratracheal intubation using a fiberoptic laryngoscope].

Experience with a new type of laryngoscope (Bullard) is reported. It weighs 1,200 kg, and has fiberoptic fibers both for lighting and viewing. Angle of vision is about 55 degrees. Endotracheal intubation with this device requires a semi-rigid stylet to bend the tracheal tube at 90 degrees just above its cuff, so as to reproduce the curvature of the laryngoscope blade. Intubation is carried out in five steps: 1) introducing the laryngoscope blade, and visualising the vocal cords through its lens; 2) introducing the tube with its stylet, just above the laryngoscope blade; 3) placing the tube between the vocal cords under fiberoptic vision; 4) adjusting tube position in the trachea, the stylet still in place; 5) removing both stylet and laryngoscope. The use of this apparatus in an obese patient with reduced mobility of the cervical spine, who was ranked 4 on the Mallampati scale, is reported. The Bullard laryngoscope enabled easy tracheal intubation (duration 1 min 30 s), whereas direct laryngoscopy and the use of a Huffman prism were unsuccessful. The fiberoptic laryngoscope may be of help in case of difficult intubation.