Canadian Journal of Anaesthesia

, Volume 42, Supplement 1, pp R31–R37 | Cite as

Airway adjuncts and alternative techniques of endotracheal intubation

  • Orlando Ricardo Hung
Refresher Courses — Saturday, June 24 (A.M.) Track II


Although conventional laryngoscopic intubation is generally effective and safe, occasionally this technique may be difficult. Numerous airway devices and alternative intubating techniques have been developed and have been demonstrated to be effective and life-saving in difficult circumstances. Anaesthetists should become familiar with some of these simple and life-saving “blind” intubating techniques. Successful intubation relies upon the selection and preparation of the patient as well as the skill and experience of the operator in using these techniques. With regular practice, intubation using these devices becomes easier and more successful.


Tracheal Intubation Epidural Catheter Difficult Airway Fibreoptic Bronchoscope Cette Technique 

Dispositifs d’appoint et techniques alternatives de l’intubation endotrachéale


Bien que l’intubation par laryngoscopie conventionnelle soit généralement efficace et sans danger, à l’occasion, cette technique peut s’avérer difficile. Plusieurs dispositifs pour l’intubation et certaines techniques alternatives ont montré leur efficacité pour l’intubation normale et comme mesures de sauvetage en situations d’urgence. Les anesthésistes devraient être familiers avec quelques-unes de ces méthodes d’intubation à l’aveugle simples mais importantes. Le succès de l’intubation dépend de la sélection et de la préparation du patient aussi bien que de l’habileté et de l’expérience de celui qui utilise ces techniques. Avec des pratiques régulières, l’intubation assistée par ces dispositifs deviendra plus facile et réussira plus souvent.


  1. 1.
    Latto IP. Management of difficult intubation.In: Latto IP, Rosen M (Eds.). Difficulties in Tracheal Intubation. London: Bailliere Tindall, 1987: 99–141.Google Scholar
  2. 2.
    Benumof JL. Management of the difficult adult airway. Anesthesiology 1991; 75: 1087–110.PubMedCrossRefGoogle Scholar
  3. 3.
    Macintosh RR. An aid to oral intubation. BMJ 1949; 1: 28.Google Scholar
  4. 4.
    Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Rao TLK, Mathru M, Gorski DW, Salem MR. Experience with a new intubation guide for difficult tracheal intubation. Crit Care Med 1982; 10: 882–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Nolan JP, Wilson ME. Evaluation of the gum elastic bougie. Intubation times and incidence of sore throat. Anaesthesia 1992; 47: 878–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Nolan JP, Wilson ME. Orotracheal intubation patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia 1993; 48: 630–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Can RJ, Belani KG. Clinical assessment of the Augustine Guide™ for endotracheal intubation. Anesth Analg 1994; 78: 983–7.Google Scholar
  9. 9.
    Krafft P, Fitzgerald R, Pernerstorfer T, Kapral S, Weinstabl C. A new device for blind oral intubation in routine and difficult airway management. Eur J Anaesthesiol 1994; 11: 207–12.PubMedGoogle Scholar
  10. 10.
    Yamamura H, Yamamoto T, Kamiyama M. Device for blind nasal intubation Anesthesiology 1959; 20: 221.Google Scholar
  11. 11.
    Weis FR Hatton MN. Intubation by use of the lightwand: experience in 253 patients J Oral Maxillofac Surg 1989; 47: 577–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Hung OR, Stevens SC, Pytka S, et al. Clinical trial of a new lightwand device for intubation in patients with difficult airways Anesthesiology 1993; 79: A498.CrossRefGoogle Scholar
  13. 13.
    Hammer M, Garry B. Transillumination of the trachea with FlexilumAnesth Analg 1985; 64: 90–3.CrossRefGoogle Scholar
  14. 14.
    Butler FS, Circillo AA. Retrograde tracheal intubation. Anesth Analg 1960; 39: 333–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Waters DJ. Guided blind endotracheal intubation Anaesthesia 1963; 18: 159.CrossRefGoogle Scholar
  16. 16.
    Anonymous. Practice guidelines for management of the difficult airway: a report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993; 78: 597–602.Google Scholar
  17. 17.
    Bourke D, Levesque PR. Modification of retrograde guide for endotracheal intubation. Anesth Analg 1974; 53: 1013–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Gerenstein RI. J-wire facilitates translaryngeal guided intubation (Letter). Anesthesiology 1992; 76: 1059.PubMedCrossRefGoogle Scholar
  19. 19.
    Lechman MJ, Donahoo JS, MacVaugh H. Endotracheal intubation using percutaneous retrograde guidewire insertion followed by antegrade fiberoptic bronchoscopy. Crit Care Med 1986; 14: 589–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Shantha TR. Retrograde intubation using the subcricoid region. Br J Anaesth 1992; 68: 109–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Abdou-Madi MN, Trop D. Pulling versus guiding: a modification of retrograde guided intubation. Can J Anaesth 1989; 36: 336–9.CrossRefGoogle Scholar
  22. 22.
    Dhara SS. Retrograde intubation— a facilitated approach. Br J Anaesth 1992; 69: 631–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Stewart RD. Tactile orotracheal intubation. Ann Emerg Med 1984; 13: 175–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Woody NC, Woody HB. Direct digital intratracheal intubation for neonatal resuscitation. J Pediatr 1968; 73: 903–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Hardwick WC, Bluhm D. Digital intubation. J Emerg Med 1984; 1: 317–20.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • Orlando Ricardo Hung
    • 1
  1. 1.Departments of Anaesthesia and PharmacologyDalhousie UniversityHalifaxCanada

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