Understanding Anesthesiology - The Global Regional Anesthesia ...

Airway Devices and Adjuncts
After performing a history and physical examination
and understanding the nature of the planned procedure,
the anesthesiologist decides on the anesthetic
technique. If a general anesthetic is chosen, the anesthesiologist
also decides whether endotracheal intubation
is indicated or whether another airway device such as a
LMA could be used instead.
When endotracheal intubation is planned, the technique
used to achieve it depends in large part on the
assessment of the patient’s airway. When intubation is
expected to be routine, direct laryngoscopy is the most
frequent approach. In settings where the airway management
is not routine, then other techniques and adjuncts
are used. Airway devices that can be used to
achieve an airway (either as a primary approach or as a
“rescue” method to use when direct laryngoscopy has
failed) are categorized below.
introducers (commonly referred to as gum elastic
bougies), stylet.
• Methods of achieving endotracheal intubation using
“indirect” visualization of the larynx: videolaryngoscope,
(the Glidescope, McGrath); Bullard laryngoscope,
fibreoptic bronchoscope.
• Methods of achieving endotracheal intubation in a
“blind” fashion (without visualization of the larynx):
blind nasal intubation, lighted stylet, retrograde intubation,
Fastrach LMA.
• Methods for securing the upper airway only. These
methods achieve what is sometimes termed a “noninvasive
airway” and include the oral airway with
mask; the LMA; and the King Laryngeal Tube.
• Adjuncts for increasing the likelihood of achieving
endotracheal intubation through direct laryngoscopy:
alternate laryngoscope blades, endotracheal
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