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n.1.One skilled in laryngoscopy.
Webster's Revised Unabridged Dictionary, published 1913 by G. & C. Merriam Co.
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Ideally, this challenging procedure should be delegated to a skilled laryngoscopist who performs ETI frequently, such as an anesthesiologist.
The other well-known techniques to improve laryngeal view are that external laryngeal manipulation by the laryngoscopist or trained assistant which is proved to improve more than 13-15% of Cormack and Lehane III & IV grade in studies done on goitre and emergency patients [7, 23].
[8,9] Difficult direct laryngoscopy refers to inability on the part of the laryngoscopist to visualise the larynx because of anatomical abnormality or distortion of the larynx or trachea.
These include the laryngoscopist's experience and technique, intubation difficulty, the application of manual in line stabilisation and patient factors such as weight, age, height and the length of maxillary incisors (9-13).
This involved notifying the patient, ensuring that special equipment and a reasonably experienced laryngoscopist were present in the room, checking for the absence of resistive patient muscle tone and finally, placing the patient in an optimal sniffing position and providing preoxygenation before induction to anaesthesia (23).
Difficult endotracheal intubation is defined as when an experienced laryngoscopist using direct laryngoscopy requires more than two attempts with the same blade or a change in the blade or use of an adjunct like bougie or use of an alternative device or technique following failed intubation with direct laryngoscopy.
The criteria for optimal attempt for orotracheal intubation is reasonably experienced laryngoscopist, no significant muscle tone, optimal sniff position, optimal external laryngeal pressure, change length of blade once, change type of blade once.
Clinical observation was made by scoring jaw relaxation, vocal cord position and response to intubation by an experienced laryngoscopist and a cumulative score was derived.