Improving patient safety by design -- a new spinal/intrathecal injection safety system.

readily be achieved with the inverted insertion (i.e., with the concave surface facing backward) of a polyvinyl chloride endotracheal tube.2 They attributed their success, in part, to the more anatomic direction of the tube on emergence from the Fastrach laryngeal mask airway with the inverted tube insertion technique. A similar “hang up” is often seen during tracheal intubation using the Bullard laryngoscope or the Glidescope together with a styletted ETT. It is our experience that softening of the ETT together with the reverse loading of the ETT on the stylet can also substantially minimize the problem with “hang ups” encountered during tracheal intubation with these devices. In order to optimize the effectiveness of reverse loading, we recommend that the bending of the ETT (70°–90o) be employed immediately prior to intubation. Otherwise, we have found that within a short period of time, the ETT will untwist itself around the well lubricated stylet. In conclusion, the ease of TrachlightTM intubation or intubation using other devices can be enhanced by warming as well as reverse loading of the ETT onto the device or an accompanying stylet.