All oral intubation techniques require opening the mouth, retracting or navigating around the tongue, and placement of an endotracheal tube. Except for intubation by digital palpation, or blind intubation through a supraglottic airway, all methods of orotracheal intubation involve a direct or indirect means of visualizing the larynx.

The traditional method of oral intubation, first publicized by Kirstein in 1895, and still the most commonly used emergency airway management technique, is direct laryngoscopy. A rigid laryngoscope blade (curved or straight) retracts the tongue and epiglottis, and exposes the patient’s larynx to a direct line of sight from the operator’s dominant pupil. Direct laryngoscopy is amongst the most effective procedures in clinical medicine; it works in more than 99% of cases. A small percentage of patients have a “difficult airway, or “difficult intubation,” which is a term commonly used to mean poor laryngeal visualization, need for repeat laryngoscope insertions, or problems passing a tracheal tube. “Difficult intubation” or “difficult laryngoscopy” is not only a function of the patient and their relevant airway anatomy. The procedure depends upon laryngoscope handling, how the blade tip interacts with perilaryngeal structures, and the operator’s ability to identify partially seen laryngeal landmarks, and then intubate a partially exposed larynx. In short, the operator is a significant variable in direct laryngoscopy as well as other methods of intubation. Intubation deices that use video cameras, fiberoptics, or other optical systems to visualize the larynx are increasing used in elective and emergency airway management. Each device has its own subtleties of use With many of these intubation devices the potentially difficult aspect of intubation becomes tube delivery, not target visualization.

Click on images below to learn more about a specific oral intubation technique:

Direct Laryngoscopy	Video Laryngoscope	Optical Laryngoscope
Flexible Fiberoptic Intubation	Optical Stylet	Digital Intubation
Fastrach LMA Intubation