The Cormack-Lehane (CL) classification grades laryngoscopic view. A grade 3 view (only the epiglottis visible, no glottis seen) is best managed by which intubation adjunct as first choice?
- A Blind nasal intubation
- B Immediate awake fibreoptic intubation under topical anaesthesia
- C Use of a gum elastic bougie with a curved tip passed below the epiglottis and railroaded with the ETT ✓
- D Retrograde intubation via cricothyroid membrane
Correct answer: C. Use of a gum elastic bougie with a curved tip passed below the epiglottis and railroaded with the ETT
Explanation
A gum elastic bougie (GEB, Eschmann introducer) is the recommended first-line adjunct for CL grade 3 views. The bougie's angled tip is directed anteriorly beneath the epiglottis; clicks felt as the tip 'walks' over tracheal rings (or hold-up in a bronchus) confirm tracheal placement. The ETT is then railroaded over the bougie into the trachea. Success rates exceeding 90% are reported for grade 3 views with this technique. Awake fibreoptic intubation is reserved for anticipated difficult airways identified preoperatively.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.