Endotracheal intubation in an adult patient fitted with a Leksell® frame using a Pentax Airwayscope® with a pediatric-type INTLOCK blade (ITL-P)

Several previous reports have established the Pentax Airwayscope® (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for tracheal intubation in adult patients. The Pentax AWS is often successfully used with an INTLOCK blade ; to date, however, INTLOCK blades have been released for neonatal and pediatric patients only. In this case, we performed tracheal intubation using a Pentax AWS attached to a pediatric-type INTLOCK blade (ITL-P) in an adult patient fitted with a Leksell® Stereotactic frame (Elekta, Sweden). The patient weighed 45 kg and was 154 cm tall, and was scheduled for a tumor biopsy due to glioblastoma in the brain stem. The patient was preoperatively fitted with a Leksell® frame on her head. The patient was not premedicated and was monitored with electrocardiography (ECG), noninvasive blood pressure, and pulse oximetry. Following pre-oxygenation, general anesthesia was induced using propofol 4.0 μg·ml^-1 with target-controlled infusion and remifentanil 0.25 μg·kg ^-1·hr^-1. After loss of consciousness, we administered 30-mg rocuronium boluses. We initially attempted tracheal intubation first using a Macintosh laryngoscope and then a Pentax AWS, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-P, we successfully achieved tracheal intubation without any complications. Anesthesia was maintained uneventfully with 3.0 μg·ml^-1 propofol and remifentanil 0.10 to 0.25 μg·kg^-1·hr^-1 in oxygen and air. Further study is needed to facilitate the effective use of the Pentax AWS and the ITL-P in such cases.