The Airway II

Upon induction of anesthesia (a topic for a future blog), we insert the blade shown above into a patient's mouth and slip it down the throat. When inserted correctly, we lift the tongue and soft tissues up from the back of the throat, hoping to see the vocal cords. Carefully, we slide an endotracheal tube through the cords, which allows us control of a patient's breathing.

In theory, it's a fairly simple procedure, but the consequences can be dire; esophageal intubations (incorrect placement) used to be the most common cause of anesthetic death. And intubation gets harder with obesity, a history of neck surgery, a big tongue, loose or broken teeth, or a host of other factors. Anesthesia residency is about learning to troubleshoot suboptimal views and developing backup plans when a simple direct laryngoscopy fails.

One of the newer technologies is to use a blade with a camera at the end. This takes away the difficulty of looking through the mouth and trying to align anatomic axes to view the vocal cords. The GlideScope, shown below, is one of our backups in a difficult intubation, but even with this, navigating the endotracheal tube through a tight passage can be challenging.

Image of Macintosh blades shown under Creative Commons Attribution 3.0 License, is from Wikipedia. Image of GlideScope shown under Creative Commons Attribution Share-Alike License, is from Wikipedia.