Background and Goal of Study: Even now, fiberoptic bronchoscope(FOB)-guided intubation(FOI) is a preferred choice for difficult airway management. The DAMS TulipTM (SENKO MEDICAL INSTRUMENT mfg. CO., Ltd, Tokyo, Japan) is a new tool to assist Bag Valve Mask (BVM) ventilation and FOI, with the following specific functions:
1. Facilitation of straight advancement of the FOB to the glottis
2. Upward lifting of the epiglottis in a unique manner
3. Alternative function as an airway and a useful aid for BVM ventilation
This study aimed is to assess the utility of the equipment for BVM ventilation and FOI.


Materials and methods: Twenty seven adult patients (age range: 26-84 years, women: men=15:12, BMI: 17-36, ASA-PS: 1-3) undergoing elective surgical procedures were enrolled. The equipment was inserted, with the patient under general anesthesia, BVM ventilation was attempted without any assistive techniques, e.g. the jaw lift. We then set the FOB on the equipment channel, inserted it, tried to reach its tip to the vocal cords, and recorded the time taken for the procedure.

Results and Discussion: Inserting the equipment was easy, and BVM ventilation was successfully achieved in all patients without any of the techniques mentioned above.
The FOB was advanced straight along the equipment path to the vocal cords. The equipment lifted the epiglottis upward, which facilitated easy detection of the vocal cords in all cases. The mean time taken for the procedure was 5.52 seconds (range. 3–10 s). All procedures were performed without aid from other staff.

Conclusions: The DAMS TulipTM lifted the epiglottis upward, maintained an open airway, and ensured clear visibility of the vocal cords. It is useful as an airway for BVM ventilation and an assistive device for FOB intubation under general anesthesia.

The DAMS TulipTM: initial assessment of performance as a new tool for assisting bag valve mask ventilation and fiber optic intubation