Local anaesthesia for ‘awake intubation’ using the TruView PCD video laryngoscope.

Editor, I would like to present a method of local anaesthesia for ‘awake intubation’, i.e. intubation in a conscious patient under local anaesthesia and sedation using the Truview PCD laryngoscope (Truphatek, Israel), for cases of anticipated difficult intubation. The use of video laryngoscopes for awake intubation has been described in the literature as a good alternative to fibreoptic intubation [1]. I described the clinical use of Truview PCD in a patient with mouth opening restricted to 1.5 cm [2]. There are many reports regarding awake intubation using various video laryngoscopes, e.g. AirTraq [3–5], Pentax-AWS [6–9], McGrath [10] or Glidescope [11, 12]. Each of these video laryngoscopes can be employed for awake intubation with the method of local anaesthesia presented below. I used this method with the C-Mac video laryngoscope (Karl-Strorz, Germany) in a patient with a large tumour of the neck after failed attempts at direct laryngoscopy. The method in question is based on local anaesthesia using 1% lidocaine injected through a catheter placed in the endotracheal tube (Fig. 1). The Truview PCD intubation stylet and a thin catheter are inserted through the tube so that the catheter tip sticks out slightly beyond the tracheal tube. When the Truview PCD is used, the insertion of the catheter with constant oxygen flow prevents steaming up of the lens, helps to maintain proper oxygenation of the patient, and helps to remove saliva from the field of vision and manipulation. After local anaesthesia typical of awake intubation [13, 14], the video laryngoscope is gently introduced into the patient’s mouth. It is helpful to insert the oropharyngeal tube to prevent the patient from biting down on the laryngoscope blade. This protects the laryngoscope, but mainly the patient from damaging his/her teeth when metal blades are employed. Once the glottic opening has been visualised, 2 mL of 1% lidocaine is administered through the catheter and sprayed over the vocal cords (Fig. 2), as in the case of awake fiberoptic intubation through the working channel of a fibrescope [14]. Subsequently, the endotracheal tube can be inserted and the catheter with the guide removed from the endotracheal tube. In the case mentioned, the patient did not react to the insertion of the endotracheal