Truview Video Laryngoscope in Patients with Difficult Airways

To the Editor: The video laryngoscope is a major technological advancement in anesthesia practice (1–3) because it captures and magnifies the image of the glottis near the tip of the laryngoscope blade. Compared with conventional laryngoscopes, a video laryngoscope may provide a better view of the glottis. Several varieties of video laryngoscopes are available, but most are expensive. In contrast, the Truview laryngoscope (Truphatek, Natanya, Israel), a Macintosh-type blade with an optical lenses attached (Fig. 1), costs about the same as conventional blades. We report successfully using the Truview laryngoscope in two patients with difficult airways in whom endotracheal intubation with a Macintosh laryngoscope had failed.Figure 1.: The Truview laryngoscope blade (Truphatek, Natanya, Israel) (above) and a Macintosh blade (below). The Truview blade can be attached to a conventional laryngoscope handle.Case 1. A 49-yr-old woman with a history of temporomandibular arthritis was scheduled for mastectomy. She had Mallampati class 2 airway, with a 2.5 finger-width gap between her upper and lower incisors. After anesthetic induction and neuromuscular blockade, we encountered difficulty opening her mouth. Laryngoscopy with a Macintosh blade could not reveal the glottis. In contrast, with the Truview laryngoscope, we could see the posterior part of the glottis, and successfully intubated the trachea with the aid of a gum elastic bougie. Case 2. A 72-yr-old man, 172 cm, 56 kg, with an unremarkable airway was scheduled for gastrectomy. After anesthetic induction and neuromuscular blockade, we tried and failed at several attempts at endotracheal intubation with a Macintosh blade. The primary problem was a large, floppy epiglottis. We inserted a Truview laryngoscope, viewed the posterior part of the glottis, and inserted a tracheal tube into the trachea with the aid of a gum elastic bougie. We have experienced several other cases in which a Macintosh blade failed to expose the glottis, but the Truview laryngoscope did. We believe that the Truview laryngoscope is a simple and inexpensive device that may be useful in patients with difficult airways. Sanae Matsumoto, MD Takashi Asai, MD, PhD Koh Shingu, MD Kansai Medical University Otokoyama Hospital Yawata City, Kyoto, Japan Kansai Medical University Moriguchi City, Osaka, Japan [email protected]