This technical note aims to introduce a new approach for intubation of patients with restricted mouth opening in cases that conventional and fiberoptic-assisted endotracheal intubation are not possible. The proposed technique is a modification to the previously well-established retrograde intubation method. The main advantage of this new technique is the employment of fiberscope for Direct visualization which eliminates the use of guide wire. The endotracheal tube enters through the nostril and is railroaded using the fiberscope as a guide. Using this new technique can prevent the complications of tracheostomy and the traditional retrograde intubation in patients that anterograde intubation is not feasible. The promising result of conducting the intubation with this approach can be considered the basis for future clinical investigation.

Background: Endotracheal intubation is known as the best and challenging procedure to airway control for patients in shock or with unprotected airways. Failed intubation can have serious consequences and lead to high morbidity and mortality of the patients. Videolaryngoscope is a new device that contains a miniaturized camera at the blade tip to visualize the glottis inDirectly. Fewer failed intubations have occurred when a videolaryngoscope was used. Other types of videolaryngoscopes were then developed,all have been shown to improve the view of the vocal cords. It may be inferred that for the professional group, including emergency physicians, paramedics, or emergency nurses, video laryngoscopy may be a good alternative to Direct laryngoscopy for intubation under difficult conditions. The incidence of complications was not significantly different between the C-MAC 20% versus Direct laryngoscopy 13%. The main goal of this review was to compare the Direct laryngoscopy with the (inDirect) video laryngoscopy in terms of increased first success rate and good vision of the larynx to find a smooth induction of endotracheal intubation. Methods: Currently available evidence on MEDLINE, PubMed, Google scholar and Cochrane Evidence Based Medicine Reviews, in addition to the citation reviews by manual search of new anesthesia and surgical journals related to laryngoscopies and tracheal intubation. Results: This review of recent studies showed that the laryngoscopic device design would result in smooth approach of endotracheal intubation by means of good visualization of glottis and the best success rates in the hands of both the experienced and novice. Video laryngoscopes may improve safety by avoiding many unnecessary attempts when performing tracheal intubation with DL compared to VL as well as easy learning of both Direct and inDirect laryngoscopy. Conclusion: The comparative studies of different video laryngoscopes showed that DL compared with VL, reveal that video laryngoscopes reduced failed intubation in anticipated difficult airways, improve a good laryngeal view and found that there were fewer failed intubations using a videolaryngoscope when the intubator had equivalent experience with both devices, but not with DL alone. And therefore, knowledge about ETI and their skills, are crucial in increasing the rate of survival.

The flow behavior around a cam shaped tube in a cross flow has been investigated experimentally using flow visualization and pressure distribution measurements. The range of attack angle and Reynolds number based on an equivalent circular diameter are within 0£a£360o and 2×104 Reeq>3.4×104), respectively. The pressure drag features are clarified in relation to the flow behavior around the tube. It is found that the highest pressure drag coefficient occurs at a=90o and 270o over the whole range of Reynolds number. Results show that the pressure drag coefficient of the cam - shaped tube is lower than that of a circular tube with the same surface area for more of the attack angles.