• Shino Hayashida, Fumiharu Yanagi, Seiji Kozuma, Shinnichi Goto, and Hiroko Nishioka.
• Department of Anesthesia, Japan Labour Health and Welfare Organization Kumamoto Rosai Hospital, Yatsushiro.
• Masui. 2005 Jun 1;54(6):694-6.

BackgroundBefore emergency medical technicians are licensed to perform prehospital endotracheal intubation, they must undergo training in the operating room setting. We investigated the incidence of cases of difficult intubation classified as Cormack & Lehane grade III or IV, because such cases are considered inappropriate for training emergency medical technicians.MethodsWe examined anesthesia records between March 2002 and April 2003, retrospectively. The survey included 585 adult surgical patients with ASA physical status I or II requiring general endotracheal anesthesia.ResultsFive anesthesiologists and three doctors from the surgical department performed laryngoscopy during this period. In initial laryngoscopy with a Macintosh blade, the view of larynx was grade I in 436, grade II in 98, grade III in 27 and grade IV in 24 patients. In 68 patients, application of cricoid pressure led to improvement of laryngoscopy grade. The use of McCoy blade was necessary for intubation in 16 patients. Out of 51 patients classified as difficult intubation grade III or IV, 35 were originally not expected to be difficult cases.ConclusionsPatients with grade I or II view of larynx with a Macintosh blade was only 91%. In order to prepare for unexpected case of difficult intubation, it is necessary to take various measures such as having instructors perform laryngoscopy.

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