Digitally Assisted Tracheal Intubation
Digitally-assisted tracheal intubation may be performed in any patient though it is generally easier in smaller adults and pediatric patients. It may be the technic of choice for infants with hypoplastic mandible, especially if the blind nasal technic is undesired or unsuccessful and appropriate fiberoptic equipment is unavailable.
Local/topical anesthesia and IV sedation or even general anesthesia may be employed. In one case reported, the infant, after topical anesthesia with 5% lidocaine by aerosol and during infusion of propofol, 20-50 mcg/kg/min, appeared to suck comfortably on the anesthesologist's finger throughout the intubation. In this case, the anesthesiologist, standing on the infant's right, turned toward the head of the table and leaned sideways over the patient.
Digitally Assisted Tracheal Intubation of Infant The gloved left index finger, lightly coated with 5% lidocaine ointment, was advanced posteriorly over the surface of the tongue in the midline. The palpating finger curved naturally around the tongue, to lie at once over the glottis. The epiglottis and paired arytenoids were palpated easily. The ETT, held like a pencil in the right hand, was advanced along the left index finger until its tip was felt to lie between the glottis and finger tip. With slight additional advancement of the tube, its end was pushed into the glottis with a flexion motion of the left index finger. Direct palpation confirmed successful intubation. The intubation took only several seconds.
The ability to perform digitally-assisted tracheal intubation may help ensure the safety of the patient with mandibular hypoplasia and represents a valuable addition to the anesthesiologist's armamentarium of tracheal intubation technics. Safety, efficacy, cost-effectiveness and widespread availability make digitally-assisted tracheal intubation especially desirable.

Greg Gordon MD