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LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 100-101

Crossed-scissor manoeuvre – An underutilised technique of mouth opening for airway management: Boon for out-of-hospital situations


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 Submission30-Apr-2020
Date of Acceptance27-Jul-2020
Date of Web Publication30-Aug-2020

Correspondence Address:
Dr. Jyoti Sharma
Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ARWY.ARWY_18_20

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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 Oct 28];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.[1] 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.[2] 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[3] (opening the mouth, protruding the mandible forward and elevating both the mandibular rami) and lingual traction.[4]

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.[5]
Figure 1: (a and b) Crossed-scissor manoeuvre to open the mouth. (c and d) Sketch showing position of the index finger and thumb

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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.[6] The crossed-scissor manoeuvre can also be extended for introduction of lighted stylets or the blade of a laryngoscope.[7],[8] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ramachandran SK, Kumar AM. Supraglottic airway devices. Respir Care 2014;59:920-31.  Back to cited text no. 1
    
2.
Newell C, Grier S, Soar J. Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation. Crit Care 2018;22:190.  Back to cited text no. 2
    
3.
Kumar D, Hayat M, Khan A. I-gel insertion with modified jaw thrust technique. Indian J Anaesth 2015;59:132-3.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Umesh G, George M, Venkateswaran R. Tongue traction is as effective as jaw lift maneuver for Trachlight-guided orotracheal intubation. Acta Anaesthesiol Taiwan 2010;48:130-5.  Back to cited text no. 4
    
5.
Skills Summaries: Insertion of an oropharyngeal airway, adult or child. The Canadian Red Cross Society 2012.  Back to cited text no. 5
    
6.
Henderson JJ, Suzuki A. Rigid indirect laryngoscope insertion techniques. Anaesthesia 2008;63:323-4.  Back to cited text no. 6
    
7.
Benumof JL. Conventional (laryngoscopic) orotracheal and nasotracheal intubation (single-lumen tube). In: Benumof JL, editor. Airway Management. St. Louis: Mosby-Year Book; 1996. p. 261-76.  Back to cited text no. 7
    
8.
Levitan RM. The Airwaycam™ guide to intubation and practical emergency airway management. Wayne: AirwayCam Technologies Inc.; 2004.  Back to cited text no. 8
    


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