Combined use of 3 video-assisted devices for difficult intubation


Recently, the Center for Anesthesia and Comfort Medicine of Xi'an International Medical Center Hospital completed a complex surgery of right rotator cuff repair, for a patient with ankylosing spondylitis combined with snoring, sinus bradycardia, and a positive atropine test. Doctors used three video-assisted devices to finish the very first important step——awake intubation under local anesthesia. These three video-assisted devices are:  SaCo Video Laryngeal Mask, Flexible Videoscope, and Video Endotracheal Tube.


For 5 years, 50-year-old Mr. Li was unable to wash his face and dress himself due to the stiffness and pain of his shoulder joint, which seriously affected his life quality. When he made up his mind to repair this shoulder joint through surgery, he hesitated. That is because he had ankylosing spondylitis, sleep apnea syndrome (commonly known as snoring), sinus bradycardia, and a positive atropine test.


Xiong Fujun, Director of the Sports Medicine Department, said that this repair surgery was not difficult in itself, but Li’s three above-mentioned diseases made anesthesia intubation very difficult!


The patient has to be operated under general anesthesia with tracheal intubation but the stiffness and bamboo-like changes in the spine of patients with ankylosing spondylitis allow very limited neck mobility and make the tracheal intubation unusually difficult.

Snoring is very likely to cause airway obstruction. In severe cases, it can even be life-threatening due to anesthetic-induced hypoxia.

While the anesthetic itself already has an inhibitory effect on the heartbeat, bradycardia and positive atropine test make the heart rate fall even further, which is hard to improve even by drug administration.

The occurrence of any of the above was a challenge for anesthesiologists.


This time, Xue Rongliang, known as the Top1 anesthesiologist in Shaanxi, faced the coexistence of three complications. He said, “this is the most difficult case I've encountered in more than 30 years of practice."

Prof. Xue performed tracheal intubation with adequate local anesthesia under conscious sedation, and finally completed the general anesthesia intubation through a combination of three devices: " Video Laryngeal Mask, Flexible Videoscope, and Video Endotracheal Tube".

The patient's vital signs were maintained smoothly during the operation, and he was fully awake 15 minutes after the operation without any complications.


Four days after surgery, Mr. Li was able to get up to 140 degrees on the shoulder joint and was excited to tell his friends and family that his hand was now able to reach the back of his head!