One aspect of intubation with a fiberoptic bronchoscope (FOB) that can be frustrating is the tendency to advance the scope into the pharynx off of the midline, failing to view the glottis and becoming “lost” in the pharyngeal mucosa. The laryngeal mask airway (LMA) provides an excellent introducer for the FOB because it is usually positioned directly atop the glottis, and whether the epiglottis is held open or folded down, it facilitates passage of the tip of the scope into the airway.¹ The size 4 LMA, in both reusable and disposable versions, can only admit a size 6.0-mm internal diameter (ID) or (at best) size 6.5-mm ID. Although such a tube is adequate in diameter for ventilation of most adults, its length is foreshortened compared with larger diameter endotracheal tubes (ETTs), and it reaches only about 1 to 2 cm past the vocal cords and into the larynx when passed through the LMA device. Therefore, long-term stability of this ETT may be an issue, as even minor movement of the head or neck may dislodge it. Furthermore, it is difficult to remove the LMA without dislodging the ETT. However, for short-term use, as in the operating room, or for emergency ventilation followed by intubation during difficult airway management in other settings, the use of the LMA to assist with FOB intubation is a valuable technique.

Several case reports support the value of using FOB to intubate through the LMA.¹,²,³,⁴