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WuScope
Introduction to The WuScope System™
 A
breakthrough in laryngoscope design:
The Combination Intubating Device™
1. What the WuScope is
Structure of the WuScope
2. How
the WuScope Works
Technique for using the WuScope
The science behind the device
3. Why
the WuScope is Better
Special features / design advantages
What
the WuScope is
Achi
Corporation presents its combination intubating device™—The WuScope
System.™ Designed by a team of anesthesiologists with special interests in
difficult laryngoscopy,1-3 it has been successfully utilized in clinical
anesthesia.4-8
 In
The WuScope System, each laryngoscope is a tubular, curved, bi-valved, rigid
blade incorporated with a flexible fiberscope as the optical guide. The WuScope integrates the desirable features of existing rigid and flexible
laryngoscopes and eliminates or minimizes their shortcomings.
The
WuScope is intended to facilitate endotracheal intubation for the routine or
difficult airway, in the awake or anesthetized patient, and via the
oral or
nasal route.
Structure of the Adult WuScope System
 1.
Rigid blade portion
a. Handle
b. Main-blade
c. Bi-valve element
When
the main-blade and the bi-valve element are positioned together, they form
two passageways, the ETT passageway and the Fibercord passageway.
Two
sizes of detachable laryngoscope blades, Large-adult and
Adult, are
interchangeable with the same handle.
 2. Flexible fiberscope portion
a. Body (eyepiece & insertion Cord)
b. Battery light source
c. Extender
The custom
Achi FA-10WUBS fiberscope is like a
portable
rhino-pharyngo-laryngoscope without the angulation control.
The
same flexible fiberscope
is compatible with Large-adult and Adult
(with Extender) rigid blades
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How the WuScope Works
The WuScope is designed to facilitate tracheal intubation with the patient's
head in the neutral position without
necessitating tongue displacement, head extension, or neck movement.
Technique for using
the WuScope
 Orotracheal
Intubation a. Introduce the properly assembled
WuScope into the patient's mouth at the midline
much like inserting a regular oropharyngeal airway.
b. Look through the eyepiece as the blade passes the
uvula, the posterior pharyngeal wall, and the epiglottis towards the larynx.
(Click here or on
figure for endoscopic view.) c. With the suction
catheter as a guide, align the ETT with the
glottis by gently moving the blade sideways, or withdrawing, advancing or
lifting up the device slightly.
d. When the ETT and the glottis are properly aligned,
advance the ETT over the suction catheter and into the glottis.
e. Remove the bi-valve element from the patient's mouth first, then
remove the handle, main-blade, and fiberscope as one unit, leaving the ETT
in place.
Limitation: a minimum mouth opening of 20-25 mm is required.
 Nasotracheal Intubation a.
Pass an ETT into the oropharynx through the nostril, and insert the device
(without attachment of the bi-valve element) through the oral route.
b. Bring the concave under-surface of the distal main-blade to
straddle the ETT. c. Guide the ETT towards the larynx,
aligning the ETT with the glottis by moving the blade sideways.
d. Slide the ETT into the larynx, then gently remove the device
The science behind the device
"Difficult airway" is a complex clinical entity—many different anatomical or
pathological factors may contribute to difficult laryngeal visualization and
tracheal intubation. We believe that mobility and space are the two
fundamental elements towards understanding and resolving the problems of a
"difficult airway."
Conventional rigid laryngoscopy demands a straight alignment of the upper
airway anatomy. We need the mobility of atlanto-occipital joint to extend
the head; we need the mobility of temporomandibular joint to open and
subluxate the jaw; and we need sufficient oropharyngeal space to displace
the tongue.2 When mobility or space is compromised, difficult visualization
and/or difficult intubation may result.
With conventional flexible fiberoptic techniques, visualization does not require a
straight alignment, therefore mobility is not an issue. However, blood,
secretion, or redundant soft tissue tends to impede the fiberoptic lens from
viewing structures; and intubating the trachea by "blindly" advancing the endotracheal tube over the fiberscope insertion cord can be problematic.
The WuScope adds to the flexible fiberscope a rigid tubular blade which
protects the lens and overcomes soft tissue obstruction. The blade is designed to ensure that
tracheal intubation is a continuously "visually
guided" procedure.
The WuScope creates viewing and intubating space in patients with short ramus, caudal larynx, obstructive sleep apnea,1-3 obesity, pharyngeal edema,
and other space-reducing anatomical or pathological conditions.6-8 The
advantages of fiberoptic tubular structure further extend the WuScope
applications to other challenging airway problems, such as managing cervical
spinal injury5 or
performing emergency awake intubation in trauma care and
tube
exchange in critical care.4,8
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Why the WuScope is Better
Special features and design advantages
Easy
maneuverability. The rigid blade adds an exoskeleton to the flexible
fiberscope, making it easier to operate.
Tubular structured
blade. The tubular structure protects the fiberoptic lens from blood,
secretion, or redundant soft tissue and creates viewing and intubating
space.
110°
embodiment of the handle and blade. The wide reversed angle enables easy
blade entry in the obese, large-bosomed, short-necked, or barrel-chested
patient.
Fiberoptic imaging
and oral airway-shaped blade. The contour of the blade allows smooth access
to the larynx without tongue displacement or head extension, making it
suitable for use in the awake or cervical spine-injured patient.
Built-in ETT
passageway. The ETT passageway provides an easy means by which to advance
the ETT when the larynx comes into view.
Separate oxygen
channel and suction mechanism. The built-in oxygen channel provides
continuous supplemental oxygen, and the regular large bore suction catheter
through the ETT lumen provides simple and effective suction.
One-person
operation. In the WuScope System, the ETT, laryngoscope, oxygen supply, and
suction catheter are all held as one unit with the left hand; the right hand
is free.
Cost-containment
feature. The WuScope System utilizes one handle and one fiberscope to fit
different sizes of laryngoscope blades, in effect creating several different
laryngoscopes.
Versatility and
aesthetic appeal. The WuScope is used for the routine or difficult airway,
in the awake or anesthetized patient, and via the oral or nasal route. The
blade design embodies an aesthetic of safety, efficacy, and simplicity.
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References
1. Chou HC, Wu TL.
Mandibulohyoid Distance in Difficult Laryngoscopy.
Br J Anaesth 1993; 71: 335-339
2. Chou HC, Wu TL.
Rethinking the three axes alignment theory for
direct laryngoscopy. Acta Anaesthesiol Scand 2001; 45:261-2
3. Chou HC, Wu TL. Large hypopharyngeal tongue: a shared anatomic
abnormality for difficult mask ventilation, difficult intubation, and
obstructive sleep apnea? Anesthesiology 2001; 94:936-7
4. Andrews SR, Norcross SD, Mabey MF, Siegel JB. The WuScope Technique
for Endotracheal Tube Exchange. Anesthesiology 1999; 90:929-30
5. Smith CE, Pinchak AB, Sidhu TS, Radesic BP, Pinchak AC, Hagen JF.
Evaluation of tracheal intubation difficulty in patients with cervical spine
immobilization: fiberoptic (WuScope) versus conventional laryngoscopy.
Anesthesiology 1999; 91:1253-9
6. Andrews SR, Mabey MF. Tubular fiberoptic laryngoscope (WuScope) and
lingual tonsil airway obstruction. Anesthesiology 2000; 93:904-5
7. Smith CE, Kareti M. Fiberoptic laryngoscopy (WuScope) for
double-lumen endobronchial tube placement in two difficult-intubation
patients. Anesthesiology 2000; 93:906-7
8. Sprung J, Weingarten T, Dilger J. The use of WuScope fiberoptic
laryngoscopy for tracheal intubation in complex clinical situations.
Anesthesiology 2003; 98:263-5
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