The Pentax-AWS system is a rigid indirect video laryngoscope with integrated tube guidance. Complications associated with this device are not well understood. We report two cases of epiglottis malposition during intubation with the Pentax-AWS. The standard technique of using the Pentax-AWS system involves direct elevation of the epiglottis for exposure of the vocal cords. The blade tip should be passed posterior to the epiglottis for laryngeal exposure, but pressure on the anterior surface of the epiglottis by the tip can rarely happen even during the correct maneuver. Although the Pentax-AWS provides clear images of the airway structures, it is sometimes difficult to observe the epiglottis continuously because the camera is located beneath the blade tip. Consequently, the view of the epiglottis from the camera may be impeded by the blade tip and may result in undiagnosed epiglottis malposition. The AWS's structural feature and its approach to the larynx can be associated with increased chance of unexpected epiglottis folding. It is particularly important to confirm normal position of the epiglottis during withdrawal of the device to prevent this complication.
