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Techniques for Nasal Intubation

Video and Optical Laryngoscopes

Video and optical laryngoscopes combine a tongue retractor (blade) with an imaging mechanism to achieve endotracheal intubation. Designs vary significantly in terms of blade design, imaging mechanisms, and the method of tube delivery.

 

The Storz C-Mac has a standard Macintosh blade with a video camera located where the light source is positioned on a German Macintosh design. The GlideScope blade has an exaggerated curved blade and an external monitor, while the McGrath and Pentax Airway Scope also have unique blade designs, but integrate their video screens directly on the handle.

glidescope Ranger
PentaxAWSdispoBlade

Pentax AirWay Scope with detached disposable blade

Glidescope Ranger with portable rugged monitor

McGrath

 

The AirTraq optical laryngoscope takes a unique approach to imaging by using prisms, mirrors, and a magnifying lens to create the image instead of a video camera.  This permits the entire device to be very inexpensive and single use; most video laryngoscopes are in excess of $8,000 while the AirTraq purchased in bulk sells for about one hundredth of this cost.  An inexpensive video camera can be connected to the viewing lens for video display.

airtrc topview

McGrath Series 5 Video laryngoscope

AirTraq Optical Laryngoscope


 

The Bullard Laryngoscope is the grandfather of all the look around the curve of the tongue intubation devices, dating back almost 30 years.  It uses fiberoptics combined with a tongue retractor. A new version of the device (now sold through Olympus) will have an integrated video system. Other devices combining fiberoptics with tongue retractors include the Wu-Scope and Upsher Scope. Although these fiberoptic instruments and the original Bullard design have no external viewing mechanism they can all be attached to an endoscopic camera.


The marriage of a hypopharyngeal perspective above the epiglottis with a means of displaying this image adds two very meaningful things to airway management: first, theses devices provide a bigger and closer view of the larynx than achieved by direct laryngoscopy; and second, they allow the operator and others to easily visualize tracheal tube passage into the larynx. These two features have very significant benefits in teaching settings and also in anticipated difficult airways.

 

A variable during intubation with these devices is the method of tube delivery.  Devices like the Glidescope and McrGrath require tube insertion to be done entirely on the monitor, since there is no direct line of sight to the larynx.  A stylet is necessary to match the curve of these instruments and introduce the tube around the curve of the tongue.  Tube insertion with the C-Mac can be partially or even completely done under direct visualization (like a standard laryngoscope, with or without a stylet), while using the monitor for verification of placement.  The AirTrtaq and the Pentax Airway Scope have taken the engineering of an intubation device one step further by combining the imaging mechanism with a tube delivery track.  With each of these devices stylets are not used. While this simplifies the procedure, it also means that tube delivery is restricted to how the device is aligned with the target, and there are some tricks to getting the tube to move where it needs to.  The Airway Scope even has a targeting mechanism integrated into the video screen.

 

airteaqwtube pentax AWS target

AirTraq with tracheal tube in track

Pentax AirWay Scope showing tracheal tube in track

Video Screen and target sights on Airway Scope

 

Every intubation device has it own subtleties of use, although the ability to routinely image the procedure does allow for rapid skill acquisition.

 

Click here for more information about the Glidescope


Click here for more information about the McGrath


Click here for more information about the Pentax Airway Scope


Click here for more information about the AirTraq


Click here for more information about the Bullard

 

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DISCLAIMER:  The procedures discussed at this website, to be performed properly, rely on complex medical skills and should only be undertaken after formal instruction and hands-on clinical training with appropriate supervision, and after receiving professional certification and authorization to do so. The content presented herein is meant to serve as just one of many resources that trainees and health care professionals should consult in the course of the their skill acquisition and ongoing practice. Airway Cam Technologies, Inc., its authors, officers, agents and assigns, disclaim any and all responsibility for any adverse outcomes and or harmful acts committed by others persons who may have consulted this website or relied on information contained herein.

 

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