Special devices and techniques
Section snippets
Lighted stylets
In 1957, Macintosh and Richards first described intubation of the trachea under direct vision, using a lighted introducer to guide the endotracheal tube (ET) through the cords [2]. The first transillumination technique to guide nasotracheal intubation was described two years later [3]. Transillumination techniques rely upon the transillumination of the trachea and tissues of the anterior neck to demonstrate the location of the tip of the ET. A well-circumscribed glow visible in the anterior
Eschmann tracheal introducer
The Eschmann introducer (Eschmann Health Care, Kent, United Kingdom, or SIMS Portex, Keene, NH), also known as a gum elastic bougie, is a 60-cm long, 15 Fr gauge stylet that is angled 40° approximately 3.5 cm from the distal end and is made from a woven polyester base. It has been popular in Europe for many years and its use was first described in 1949. This introducer may be used in one of two ways. It may be advanced through the ET until the tip protrudes from the ET; the tip may then be
Rigid laryngoscopes
Various laryngoscopes have been described since MacEan, a distinguished surgeon of the Glasgow Royal Infirmary, first used his fingers to guide an ET into the trachea in 1878 [2]. Hundreds of laryngoscope blades have since been described, yet it is beyond the scope of this article to discuss them all. Rather, only a number are selected and important differences highlighted.
Indirect fiberoptic laryngoscopes
Conventional direct laryngoscopy requires wide-mouth opening, flexion of the cervical spine, and extension of the atlanto-occipital joint in order to create a direct line of vision from the mouth to the vocal cords. In certain conditions, positioning in this fashion is not possible and may even be contraindicated. Also, it may be impossible to visualize the larynx using DL because the curve between the front teeth and the larynx cannot be straightened. New fiberoptic laryngoscopes have been
Summary
Management of the difficult airway remains one of the most challenging tasks for anesthesia care providers. Most airway problems can be solved with relatively simple devices and techniques, but clinical judgment borne of experience is crucial to their application. As with any intubation technique, practice and routine use improve performance and may reduce the likelihood of complications. Each airway device has unique properties that may be advantageous in certain situations, yet limiting in
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