Skip to main content

The left molar approach is a technique to improve the view at laryngoscopy using a standard macintosh laryngoscope. It was described by Yamamoto1 as follows:
  • insert the blade from the left corner of the mouth at a point above the left molars;
  • the tip of the blade is directed posteromedially along the groove between the tongue and the tonsil until the epiglottis and glottis come into sight;
  • before elevating the epiglottis, the tip of the blade is kept in the midline of the vallecula and the blade is kept above the left molars;
  • the view provided is framed by the flange, the lingual surface of the blade, and the tongue bulged to right of the blade.
The success of this approach in comparison with alternatives has been reproduced by others2. However although Yamamoto and others demonstrated that this improved the laryngoscopic view, actual intubation may still be difficult because of the limited access to the cords, in part caused by the bulging of the tongue.


The take home message ,if I have a grade IV view despite my usual first-pass success optimisation manoeuvres such as positioning, reducing or releasing cricoid pressure, and providing external laryngeal manipulation, it is worth trying the left molar approach  .


1. Left-molar Approach Improves the Laryngeal View in Patients with Difficult LaryngoscopyAnesthesiology. 2000 Jan;92(1):70-4 Full Text
2. Comparative Study Of Molar Approaches Of Laryngoscopy Using Macintosh Versus Flexitip BladeThe Internet Journal of Anesthesiology 2007 : Volume 12 Number 1
3. The use of the left-molar approach for direct laryngoscopy combined with a gum-elastic bougieEuropean Journal of Emergency Medicine December 2010 ;17(6):355-356
Labels:

Comments

Post a Comment

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.
Post a Comment
Read more

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...
5 comments
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more