Category: Intubation

Cuffed vs. Uncuffed Endotracheal Tube In a Child: Pros and Cons

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When intubating children, the question always arises whether to use a cuffed or an uncuffed endotracheal tube (ETT). Historically uncuffed endotracheal tubes have been used when the child is less than about 8 years old. Why is it that we can get away with using an uncuffed tube in a young child, but not an adult? The answer comes from the difference in airway anatomy between child and adult. Understanding the advantages and disadvantages of using uncuffed and cuffed tubes in children is important to safe patient care. Read More …

photo awake fiberoptic intubation

Anticipated Difficult Intubation: Should I Intubate The Patient Awake?

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For every intubation, you must decide whether it is safer to proceed with the patient awake or asleep. Many clinicians are uncomfortable with awake intubation and reserve it as a last resort, often because of limited experience or concern that the patient will remember the procedure negatively. However, awake intubation can be both safe and well tolerated in many situations. This article reviews key factors that help determine when awake intubation is the better choice. Read More …

An anesthesiologist assesses extubation criteria as he prepares to extubate a patient

Challenges in Extubation: A Case Study Analysis

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Deciding when to extubate a patient safely can sometimes be a difficult decision. Removal of an endotracheal tube when you are not sure of the diagnosis is a risk not to be taken lightly. This case discusses assessing extubation criteria in the face of ambiguous respiratory symptoms. Read More …

A Trick for Difficult Intubation in a Micro Preemie

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Post describes detailed account of a challenging intubation procedure for a micro preemie. Case description and discussion of high-risk factors. #FOAMED #anesthesia # neonatology Read More …

Using Video Laryngoscopy For Nasal Intubation

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, using video laryngoscopy for nasal intubation can be technically challenging. Use of a nasal airway and a pediatric bougie can greatly simplify this task. #anesthesia #FOAMED Read More …

Nasal Intubation

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Nasal intubation needs attention to anatomy to avoid complications. Technique: nasal intubation combined with direct laryngoscopy described. #anesthesia #FOAMED Read More …

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Failed Airway: A Supraglottic Airway Can Rescue Your Patient!

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Inserting a supraglottic airway in a failed airway emergency can rescue your patient and allow successful oxygenation and ventilation. management of failed airway, can’t intubate can’t ventilate discussed. #anesthesia, #FOAMED Read More …

Cricoid Pressure Requires Communication & Teamwork

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To be effective, cricoid pressure must be applied using the correct force, at the correct spot, using the correct angle. It therefore, requires good communication between intubator and the applier. Article discusses technique. #FOAMED Read More …

Avoid Nasotracheal Intubation Trauma By Using A Red Rubber Robinson Catheter

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Nasotracheal intubation can cause nosebleeds. One way to minimize trauma to the nasal turbinates is to shield the tip of the endotracheal tube inside a Red Rubber Robinson catheter. Article discusses technique and alternatives. #FOAMED Read More …

Extubation: Plan The End At The Beginning

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Anesthesia providers frequently prepare for difficult intubation, but may take extubation for granted. The anesthesia provider should treat extubation with the same degree of caution as intubation. Article discusses extubation criteria, technique, and precautions. Read More …

COVID-19 Intubation: Protect Yourself

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Healthcare workers are at high risk of infection from respiratory illness during intubation and other aerosol generating activity. Article discusses risk and strategies to improve personal safety. Contains links to helpful on-line materials. Read More …

CT scan of retropharyngeal abscess in a 5 year old child demonstrating airway distortion

Decision-Making: Airway Abscess In A Child

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The practice of anesthesia requires development of good decision-making processes, in addition to remembering knowledge and learning skills. This article explores the decision process that was used for a case of securing the airway in a young child with a large airway abscess. Read More …

Intubating With A Pediatric GlideScope

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Intubating an infant or young child with a GlideScope requires age specific blades and modified technique because the anatomy of infants and toddlers differs from adults. This article discusses the modification of technique to improve successful pediatric intubation with the GlideScope. Read More …

Learning Intubation: A Beginners Guide

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To learn intubation in addition to learning the physical steps, you need to understand why you’re doing those steps. This article will explain how to perform the steps of intubation, as well as the rationale behind them. Links to other articles on intubation technique appear both in the body of the text as well as repeated as a list at the end. Read More …

Photo of sweeping the tongue to the left. with the curved blade during direct laryngoscopy

First Pass Intubation: When You Can’t See The Cords

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Failure to see the cords on first pass intubation occurs about 10% of the time. This article describes the thought process behind the next steps for approaching the next intubation attempts. Read More …

Illustration from Airway Management, Anesthesiology news supplement August 2019

Airway Management Review Article Published: 10 Common Pediatric Airway Problems — And Their Solutions

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My review article has just been published in Anesthesiology News: 10 Common Pediatric airway Problems — And Their Solutions. The trend to only use pediatric providers has a seriously negative unintended consequence: It deprives other providers of routinely caring for children, making them less prepared for when they do inevitably have to care for a small child. This reviews the most important pediatric airway differences. Read More …

cover image from article "10 Rules for Approaching Difficult Intubation: Always Prepare For Failure" from the journal Airway Management from Anesthesiology News

# 1 Review Article for Anesthesiology News 2018: 10 Rules for Approaching Difficult Intubation by Christine Whitten

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And the numbers are in, my review article for Anesthesiology News was actually THE MOST viewed article on the site for the whole year! The link for the article is included. Please feel free to share.
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The MAC Blade, The Vallecula, and the Hyoepiglottic Ligament

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Intubation with the MAC blade requires precise placement of the tip of the blade in the vallecula in order to manipulate the hyoepiglottic ligament and lift the epiglottis. This discussion uses illustration, Xray, and video to demonstrate proper intubation technique. Read More …

Learning Intubation: Head Position Effects Laryngeal View

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When first learning intubation,  a beginner often concentrates on memorizing the key laryngeal anatomy. This is important of course. If you can’t recognize the vocal cords, you will not be able to successfully intubate. However, even more important to learning intubation is understanding how the larynx relates to the other structures in the head and neck. In order to intubate you must manipulate those other structures to bring the larynx into view. This post uses lateral X-rays and CT scan images to help novice intubators master the anatomical relationships they must know to intubate. Read More …

photo of inserting the ETT first, followed second by the Glidescope

GlideScope Technique For Intubation In Small Mouths

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The GlideScope can be difficult to use in a patient with a small, narrow mouth. This article discusses a technique for improving successful intubation in that type of patient. Read More …