Unanticipated Difficult Direct Laryngoscopy: Methods to Improve Its Success

  • Mark E. Nunnally
  • Michael R. Hernandez


When faced with a difficult intubation, one might abandon direct laryngoscopy in favor of another intubation technique. As technology promises to render the improbable routine, it is difficult to generate interest in a traditional airway technique such as direct laryngoscopy, especially when it proves to be difficult. However, direct laryngoscopy has also benefitted from technological advances. Illumination has improved with brighter sources such as light emitting diodes (LED) or fiberoptic light transmission replacing the direct light of incandescent bulbs. Battery longevity in modern laryngoscope handles is improved, including rechargeable options. Magnetic resonance imaging compatible (non-ferromagnetic) blades and disposable laryngoscope blades and handles have been designed. Despite these advances, interest in direct laryngoscopy, especially when it becomes difficult, pales in comparison to the excitement surrounding the use of a multitude of newer video-driven airway devices. Innovation and technological advancement in airway management are inevitable and desirable, but the simplicity and sheer efficacy of direct laryngoscopy remain constant. New airway techniques must always be evaluated against a “gold standard,” and for most airway devices, the gold standard is direct laryngoscopy. In the setting of difficult laryngoscopy, it is important to recognize that techniques and tools can facilitate difficult intubation and that a difficult airway need not be an absolute contraindication to the use of the technique.


Cervical Spine Airway Management Direct Laryngoscopy Cervical Spine Injury Difficult Intubation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical CareUniversity of Chicago Medical CenterChicagoUSA
  2. 2.Anesthesia and Critical CareUniversity of Chicago Medical CenterChicagoUSA

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