Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
Highlights
The historical information about the insertion of various kinds of tubes into the airway to facilitate ventilation can be found from 3600 B.C. in ancient Egypt [1]
This narrative review strives to contribute by upgrading the evidence on the available optical devices, introducing new advancements related to the design and technologies, and explaining the possibilities when direct laryngoscopy or videolaryngoscopy is not feasible
The AuraGain device showed a significantly higher success rate of tracheal intubation—100% vs. 79% and exhibited higher oesophageal seal pressure. Both i-gel supraglottic airway and AuraGain laryngeal mask were found as reliable conduits for fiberoptic intubation in morbidly obese patients, and they provided a good quality view to the vocal cords with effective oxygenation during tracheal intubation [22]
Summary
The historical information about the insertion of various kinds of tubes into the airway to facilitate ventilation can be found from 3600 B.C. in ancient Egypt [1]. Hippocrates identified the cartilage defects as the most serious complication following tracheotomy in about 400 B.C. The pioneer scientific information about tracheal intubation was published at the beginning of the last century. The very first article comes from 1900 and depicts medical decision making in laryngeal stenosis due to diphtheria: “tracheal intubation is considered to be less dangerous than the tracheotomy” [4]. Since 1900 more than 44,000 articles having a “tracheal intubation” as a keyword have been published in the PubMed database. Technological advances enable more frequent use of new devices, which may be very useful and safe in various circumstances in the clinical practice of airway management
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