A history of tracheal intubation

Abstract

The control of the airway with a tracheal tube is usually regarded as the 'Gold standard' of airway management. The general acceptance of a tracheal tube for resuscitation, intensive care and anaesthesia means that it has been, until very recently, regarded as the only reliable method of airway control. Only the introduction of the Laryngeal Mask Airway (LMA) by Brain 1 in 1983 has provided any real challenge to this standard. However during the evolution of resuscitation and anaesthesia tracheal intubation has not been so widely accepted, moreover its usage illustrates a common occurrence in medical history, that of a technique being discovered, abandoned and then rediscovered. Even prehistoric man must have noted that the cessation of respiration lead to death. There are references in the Bible to suggest that mouth-to-mouth expired air ventilation was used in resuscitation. However in these very early references there is no mention of using equipment, like a tracheal tube, in any way. Even this very basic resuscitation procedure decreased in popularity during the Middle Ages when it was thought that trying to revive the apparently dead was interfering with an act of God. This idea was carried to considerable extremes, for example it was prohibited for anyone, even a physician, to touch a corpse until a court officer had inspected it in Amsterdam in 1526. Despite these constraints on human practice, the physiological effects of intubation and ventilation became understood through animal work. In 1543, Andreas Vesalius, a Belgian anatomist, wrote in his book De Fabrica Humani Corporis of an experiment in which he kept a pig alive, despite having opened the thoracic