Face-to-face intubation, also known as the “Tomahawk” or “Pickaxe” method. It can be used for patients entrapped in the vehicle  or in patients with spondyloarthrosis. Morbidly obese patients may benefit from face-to-face intubation because the head elevated position allows for better oxygnenation during induction of anesthesia . However, this method needs experience and can be used after proper training, for example in manikin model .
Our study demonstrated the utility of 2 videolaryngoscopes and video intubating laryngeal mask in face-to-face endotracheal intubation. According to literature, our measured times of intubation do not exceed the results of other studies., There are publications describing a possibility of using Macintosh laryngoscope in face-to-face intubation., But in our opinion the video laryngoscope is better suited for this technique, achieving higher effectiveness, shorter intubations time and conveniences for anesthetist. Some authors report, that inverse intubation can be performed by one person successfully and does not demand an assistant., The anesthetist (standing on the left side of the patient) can hold a video laryngoscope with his right hand and insert the tube with the left one., It is optional to introduce the device with the left hand (like in traditional approach) and after obtaining satisfying larynx inlet visualisation, relocate a video laryngoscope to the right hand and insert intubation tube with the left one. Independently from the method, a video laryngoscope is a better choice than traditional Macintosh device undoubtedly.
There are many of publications comparing an effectiveness of video laryngoscopes. However, a number of researches involving face-to-face approach is limited. Arslan et al. indicated superiority of Airtraq over Glidescope during inverse intubation, achieving intubation times 14 s vs 25 s. respectively. The authors did not find a report consisting a comparison of Airtraq and Kingvision devices regarding inverse intubation conditions, however there is a publication demonstrating the predominance of Airtraq during traditional intubation.
The TotalTrack video intubating laryngeal mask is a device which enables ventilation (and oxygenation) patient during attempts of visualisation of entrance to larynx and intubation. This is especially important in case of morbidly obese patients, who have limited oxygen reserves and can desaturate very fast . TotalTrack VILM is a curved laryngeal mask and allows for ventilation. Additionally it has channel for tube and camera with monitor to observe entrance to larynx. The successful use of TotalTrack VILM is described in obese and superobese patients [14,15]. This device for intubation works similarly to AirTraq – has channel for tube. The difference in using of channelled and non-channelled video airway devices is important regarding training, usage and effectiveness. When comparing channelled and non channelled devices for intubation in face-to-face technique Choi and all found out that Pentax AWS which is channelled VL allows for faster intubation in such conditions than C-Mac and Glidescope which is not channelled VLs .
In our study all patients were intubated successfully and there were no complications during anesthesia and post-anesthesia period observed. The anesthetists have not noticed differences in usage and effectiveness between examined devices.