Rigid indirect laryngoscopy (RIL) can overcome some of the problems inherent to direct laryngoscopy and intubation using a flexible bronchoscope, but it has its own drawbacks. There is no ideal intubation device. This chapter discusses the design and technical features of rigid indirect laryngoscopes. No classification of equipment has yet been generally accepted, and a simple scheme is discussed: optical stylets, bladed indirect laryngoscopes, and tube-guiding indirect laryngoscopes. RILs allow visually controlled TT placement and visual confirmation of the tube passing between the vocal cords. RILs eliminate the need to align the axes of the upper airway and in general require less force to achieve a good view of the laryngeal inlet compared to DL. The built-in optics and electronics usually allow viewing of the image by multiple spectators and also allow documentation of successful intubation. The market for RILs is fast-moving.

Understanding the equipment, knowledge of airway anatomy, good endoscopy skills, correct choice of tubes and railroading techniques are vital to the success of flexible fibreoptic intubation techniques. The modern day flexible fibreoptic scope consists of the following parts: body, insertion cord, light source, and camera and monitor. There are three ways in which an endoscopist can manipulate the tip of the fibrescope towards the desired target. These are advancement, tip deflection and rotation. Fibreoptic endoscopy involves guiding the tip of the fibrescope from the nose or the mouth into the trachea under continuous vision. The final stage of fibreoptic intubation involves railroading the tracheal tube and removing the fibrescope from the tube. Flexible fibreoptic intubation has revolutionised the management of patients with known anatomical airway difficulties. The practical fibreoptic techniques include awake fibreoptic intubation, asleep fibreoptic intubation, and retrograde fibreoptic intubation.