Abstract
New airway equipment has recently become available that has reduced morbidity and mortality. However, airway disasters still occur. This article discusses the prudent escalation of the use of advanced airway equipment to prevent these disasters. We illustrate when and how to use a gum elastic bougie and a video-laryngoscope (VL). We also strongly recommend the combined use of the VL together with a flexible intubation scope (FIS) for both asleep and awake intubation when dealing with a genuinely difficult airway. Blind intubations should no longer be performed today. When an airway has been recognized as difficult it is the safest to aim for an awake or at least a spontaneously breathing intubation if circumstances do not allow for an awake intubation. Emergency cricothyroidotomy needs to be prepared for so that it can be executed rapidly in case the attempted awake intubation leads to complete airway obstruction.
Highlights
The availability of new airway equipment has been expanding at a steady pace in recent years in the operating room and in the pre-hospital environment and in the critical care unit [1,2]
The combination of a bougie with a VL is not recommended in this situation because the bougie cannot be steered into the airway like a flexible intubation scope (FIS)
New airway devices have recently become available and anesthesia care providers need to become facile with their use
Summary
The availability of new airway equipment has been expanding at a steady pace in recent years in the operating room and in the pre-hospital environment and in the critical care unit [1,2]. One of the inherent problems of VLs is that they allow the visualization of the cords by looking around the corner but they do not always allow for easy intubation because they do not line up the oral, laryngeal and pharyngeal axes as efficiently as a DL This issue is significant in patients with an anterior airway where the ETT first needs to ante-flex to enter the cords and retro-flex to advance further into the trachea. During intubation with a VL the ETT will occasionally pass through the vocal cords but stop advancing This is especially likely when the patient has an anterior airway. With the judicious and rapid escalation in the use of advanced airway equipment described in this article the need for an emergent cricothyroidotomy should be reduced in the future
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