Chapter 3 - Tracheal Intubation

Summary

Tracheal intubation is a fundamental skill in airway management and there are several techniques used to achieve this. Classically, the use of a laryngoscope has been used for intubation of the airway by allowing direct visualisation of the glottis. A range of laryngoscopes exist with differences in their blades and sizes with the Macintosh blade the most frequently used. Other laryngoscopes discussed include the Miller and McCoy. Videolaryngoscopes consist of a high-resolution camera at the tip of the blade to allow for indirect visualisation of the glottis. Similarly, the range of shapes and sizes is vast. The use of videolaryngoscopes has introduced the ‘shared screen’ principle allowing others to also have a view during intubation and this can aid training and teaching. Awake tracheal intubation can be performed using flexible scopes or videolaryngoscopes and is recommended for anticipated difficult airway cases. Confirmation of tracheal tube placement is critical and should be performed in every case using capnography. Clinical signs may be unreliable and additional uses of flexible scopes and ultrasound may also be used.