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Difficult laryngoscopy improved with a Miller blade

may be caused during the initial phase of insertion of the Airtraq blade over the back of the tongue. Furthermore, the Airtraq ’s viewfinder provides a narrower field of vision than conventional direct laryngoscopy, making it less likely that airway trauma will be noticed if it does occur. Dhonneur et al. [3] evaluated the use of a reverse manoeuvre to facilitate intubation of morbidly obese patients with the Airtraq . They state that ‘no complications related to anaesthesia or airway management occurred’, but note the occurrence of mucous membrane bleeding in two out of 40 lean and 10 out of 40 obese patients. This occurred despite the use of video-controlled tracheal intubation. The incidence of ‘oropharyngeal lesions’ was reduced with the reverse manoeuvre when compared to the standard Airtraq insertion technique (2 vs 10, p < 0.05). The authors comment that ‘almost all the oropharyngeal injuries were related to difficult pharyngeal insertion of the Airtraq laryngoscope using the standard insertion technique’. The Airtraq has been favourably evaluated in a number of patient [3–5] and manikin studies [1, 2, 6, 7]. It has been used successfully in cases of failed conventional intubation [9] and as an aid to awake intubation [10]. We hope that this case report adds to the evolving body of knowledge regarding this potentially useful device.