|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 100-101
Crossed-scissor manoeuvre – An underutilised technique of mouth opening for airway management: Boon for out-of-hospital situations
Jyoti Sharma1, Prashant Kumar2, Satyavir Singhal3
1 Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
2 Department of Anaesthesiology, Pt. BD Sharma, PGIMS, Rohtak, Haryana, India
3 Department Of Anaesthetics, Royal Victoria Hospital, Belfast, UK
|Date of Submission||30-Apr-2020|
|Date of Acceptance||27-Jul-2020|
|Date of Web Publication||30-Aug-2020|
Dr. Jyoti Sharma
Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma J, Kumar P, Singhal S. Crossed-scissor manoeuvre – An underutilised technique of mouth opening for airway management: Boon for out-of-hospital situations. Airway 2020;3:100-1
|How to cite this URL:|
Sharma J, Kumar P, Singhal S. Crossed-scissor manoeuvre – An underutilised technique of mouth opening for airway management: Boon for out-of-hospital situations. Airway [serial online] 2020 [cited 2020 Nov 24];3:100-1. Available from: https://www.arwy.org/text.asp?2020/3/2/100/293959
Since the introduction of the classic laryngeal mask airway in 1988, the supraglottic airway device (SAD) family has grown exponentially. SADs have largely replaced the need for orotracheal intubation and all over the world, most general anaesthetics are now delivered with SADs being used to maintain the airway. Further, during cardiopulmonary resuscitation, airway management has been simplified and interruption in chest compressions has been minimised by using SADs in preference to endotracheal intubation as the primary airway adjunct by many emergency medical service practitioners. Many techniques devised and described in literature have claimed to be useful for easy insertion and better placement of the SAD.
Whichever device is selected for airway maintenance, it cannot be introduced without manoeuvres to open the airway. Commonly used manoeuvres include jaw thrust with the nondominant hand, single-handed chin lift, modified jaw thrust (opening the mouth, protruding the mandible forward and elevating both the mandibular rami) and lingual traction.
One technique which can be easily used by a single operator to open and maintain the mouth open during SAD insertion is the 'crossed-scissor manoeuvre'. The technique involves crossing the index finger and thumb of the operator's nondominant hand like the blades of a scissor. While the index finger rests on the maxillary teeth, the thumb is placed over the mandibular teeth and the two crossed, resulting in opening of the mouth [Figure 1]. This manoeuvre not only provides adequate mouth opening (MO) but also obviates the need for other manoeuvres such as head tilt-chin lift. Use of the crossed-scissor manoeuvre can allow healthcare professionals to secure the airway without needing to wait for trained airway managers. A similar technique has been proposed by the Canadian Red Cross Society in their first-aid manual for placement of an oropharyngeal airway.
|Figure 1: (a and b) Crossed-scissor manoeuvre to open the mouth. (c and d) Sketch showing position of the index finger and thumb|
Click here to view
Use of crossed-scissor manoeuvre is not only simple to execute but also helpful for all healthcare personnel requiring to secure airway with increased success rate especially in an emergency or in out-of-hospital situations as well as while performing laryngoscopy including indirect laryngoscopy. The crossed-scissor manoeuvre can also be extended for introduction of lighted stylets or the blade of a laryngoscope., Keeping the fingers as far to the left of the mouth as possible not only gives adequate MO but also leaves plenty of room for insertion of any device including a SAD. Impressed by the simplicity and efficacy of the crossed-scissor manoeuvre, we incorporated it to facilitate the insertion of SADs in 15 consecutive patients who needed the insertion of an SAD (10 i-gel® and 5 Ambu® Aura-i™). We did not encounter any difficulty in the insertion of SAD as the manoeuvre created adequate MO. In addition, we did not require any extra manoeuvre for MO or jaw lift. Encouraged by the experience of our initial few cases, we plan to conduct a comparative study of different techniques of MO to facilitate insertion of an SAD.
We believe that the crossed-scissor manoeuvre is a simple yet underutilised manoeuvre which can be used for opening the mouth during most airway manipulations. It may prove especially useful in out-of-hospital situations.
Declaration of patient consent
The authors certify that they have obtained the appropriate patient consent form. In the form, the patient has given his consent for his images and clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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