Epiglottic downfolding during endotracheal intubation* An alternative technique to improve glottic exposure, and facilitate intubation?

Videolaryngoscopy with a Macintosh design videolaryngoscope is usually
performed with the blade in the vallecula and the epiglottis elevated from the
vocal cords indirectly, as in direct laryngoscopy. During an audit of
videolaryngoscopic practice, we noticed that, in obtaining the best view,
clinicians frequently and inadvertently advanced the blade into the vallecula
such that the epiglottis was downfolded and elevated directly from the vocal
cords. However, a better view does not necessarily lead to higher intubation
success. Moreover, epiglottic downfolding could result in more complaints as
dysphonia, sore throat and dysphagia.
With this study we want to investigate whether epiglottic downfolding leads to
a better view of the glottis. Also, we want to investigate whether epiglottic
downfolding results in more successful intubations and more complaints of
dysphonia sore throat, dysphagia and coughing.

We want to determine if epiglottic downfolding leads to a better view of the
glottis and more successful intubations. We also want to investigate if this
comes at the cost of more postoperative sore throat, dysphonia, dysphagia and
coughing complaints of patients.

Randomized controlled

Risks and burden are negligible, patients will be anaesthetised in a
conventional matter and apart from the study protocol, intubation would still
be mandatory. When participating in this study, patients will be intubated only
once (as when not participating). The difference will be the achievement of
epiglottic downfolding. We believe this not a harmful procedure, which occurs
often without the anaesthesiologist noticing. The fact that epiglottic
downfolding will be visible makes it possible to correct the position of the
epiglottis once the endotracheal tube has been placed.