Understanding Anesthesiology - The Global Regional Anesthesia ...

Movie 1.1 Intubation technique
The blade is advanced into the vallecula which is the
space between the base of the tongue and the epiglottis.
Keeping the wrist stiff to avoid levering the blade, the
laryngoscope is lifted to expose the vocal cords and
glottic opening. The ETT is inserted under direct vision
though the cords. A size 7.0 or 7.5 ETT is appropriate
for oral intubation in the adult female and a size 8.0 or
8.5 is appropriate in the male. A full size smaller tube is
used for nasal intubation.
Movie 1.1 demonstrates the important technique to use
when performing endotracheal intubation.
Video filmed and produced by Karen Raymer and Brian Colborne
pose the glottis. This technique is called direct laryngoscopy.
The patient should first be placed in the “sniffing
position” (Figure 3) in order to align the oral, pharyngeal
and laryngeal axes. The curved Macintosh
blade is most commonly used in adults. It is introduced
into the right side of the mouth and used to
sweep the tongue to the left (Figure 6).
The view of the larynx on laryngoscopy varies greatly.
A scale represented by the “Cormack Lehane views”
allows anesthesiologists to grade and document the
view that was obtained on direct laryngoscopy. Grade 1
indicates that the entire vocal aperture was visualized;
grade 4 indicates that not even the epiglottis was
viewed. Figure 7 provides a realistic depiction of the
range of what one might see when performing laryngoscopy.
Movie 1.2 shows you the important anatomy to recognize
on a routine intubation.
18