A modified Cormack-Lehane grade 3 view (epiglottis visible, no vocal cords seen) is obtained on direct laryngoscopy. Which adjunct is MOST likely to facilitate successful intubation as the next manoeuvre?

• A Increasing the size of the laryngoscope blade to provide greater lifting force
• B Performing cricoid pressure to bring the larynx into view
• C Administering suxamethonium to relax the jaw and obtain a better view
• D Using a gum-elastic bougie (stylet) passed blindly beneath the epiglottis and rail-roading the ETT over it ✓

Explanation

For a Cormack-Lehane grade 3 view (epiglottis visible, arytenoids not seen), the Eschmann introducer (gum-elastic bougie) is the first-line adjunct. The bougie is inserted at 45° anteriorly below the epiglottis toward the trachea; tracheal placement is confirmed by 'clicking' (tracheal rings) and hold-up at 25–35 cm depth (carina). The ETT is then rail-roaded over the bougie. Success rate for grade 3 intubation improves to >90% with bougie. Cricoid pressure does NOT improve laryngoscopic view (it may worsen it); external laryngeal manipulation (BURP) is used to improve view.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.