22 - Blind Intubation Techniques

Abstract

Modern methods of laryngoscopic tracheal intubation did not emerge until early in the 20th century and, over the years, direct laryngoscopic intubation has been shown to be an effective, safe, and relatively easy technique. Difficulties and failures associated with this technique have driven the development of many alternative intubation devices and techniques such as rigid and flexible endoscopes, video-laryngoscopes, and optical intubating stylets. Unfortunately, all these methods of intubation have limitations, especially in the presence of specific anatomical variations or during emergency situations where fogging, presence of blood, secretions, and vomitus are frequent. Moreover, some of these devices are substantially more expensive than the laryngoscope. These difficulties and limitations have motivated the search for non-visual techniques such as digital intubation, blind nasal intubation, and retrograde intubation, all of which have proven to be simple, effective, safe techniques. Furthermore, several devices have been developed to enable the clinician to pass the ETT “blindly” or “non-visually” into the trachea. While some may find non-visual techniques obsolete, we believe that the basic principle of airway management is to provide adequate oxygenation to patients and this should depend on the tools available to clinicians in their particular environment and on the specific clinical situation they are facing.