A comparison of left molar macintosh laryngoscope with gum elastic bougie and Bonfils intubation fiberscope for tracheal intubation in patients with simulated restricted neck mobility

conventional intubation techniques require movement of cervical spine to align the three axis to allow direct vision of the vocal cords. cervical collar may reduce the neck movements and mouth opening and makes larynx more anterior, thus making intubating conditions extremly challenging.  Bonfils intubation fiberscope is being increasingly used to facilitate intubation in anticipated and unanticipated difficult airways with good success rates. it has also been shown to markedly improve the intubation success in patients with cervical collar. but this device is expensive , may not be available and has a steep learning curve.

In modern era of technology direct laryngoscopy remains most readily available and fastest means of securing the airway in patients .Left molar approach to direct laryngoscopy improves the glottic view in simulated DA and may help negate the advantage of bonfils intubation fibersope. So ,we hypothetised that bougie assisted left molar approach to laryngoscopy may be a good alternative to Bonfils for intubation in patients with rigid cervical colalr for intubation.