ABSTRACT
J Surgeon’s tip Discuss with the anaesthetist the choice of endotracheal tube (south facing RAE or microlaryngoscopy tube) and the side on which the tube should be secured.
4 Inserting the scope Protect the upper teeth with a mouth guard or a wet swab in edentulous patients. Lubricate the scope with a water-based gel. Using your dominant hand, introduce the endoscope into the mouth, in the direction of the posterior pharyngeal wall. Using the other hand, keep the mouth open and protect the lips from damage (26.5, 26.6). JJ Advance the laryngoscope to the pharynx and uvula, being careful not to dislodge the endotracheal tube. Angle the scope to left and right and examine the tonsil fossae. Lift the scope as it is advanced in the midline pushing the tongue base up, with the endotracheal tube below the scope. Follow the endotracheal tube and advance the scope until you see the epiglottis. Examine the valleculae. Advance the scope under the epiglottis into the laryngeal inlet. Examine the supraglottic larynx, aryepiglottic folds, the infrahyoid laryngeal surface of the epiglottis, and the ventricular bands or false cords. Ensure you have a clear view of the whole of the larynx, vocal cords, and the anterior commissure. JJJ
5 Manipulation of the larynx Use external movement of the laryngeal framework to visualise all recesses of the larynx. Use ‘cricoid pressure’ to achieve a view of the anterior commissure.
