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

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 …

Intubation During Cardiac Resuscitation

Intubating patients during cardiac resuscitation is often challenging because of the circumstances surrounding the intubation. Excitement and apprehension accompany this life saving effort. In addition, The patient is often in a less than optimal position while chest compressions are in progress. You usually find the patient in one of two awkward positions: on the ground or in a bed. This article discusses techniques to better manage intubation during cardiac resuscitation, especially with the patient in an awkward position. Read More …

Hair Style Can Impact Intubation

Last weekend I spent time with the charity group Healing Little Heroes at the San Diego Rady’s Children’s Hospital, and Ronald McDonald House. The mission of Healing Little Heroes Foundation is to help pediatric patients in hospitals and outpatient settings to heal emotionally and mentally by appearing as Superheroes. My good friend, and general surgeon, Justin Wu, dressed below as Darth Vader, set up the Foundation.

On this day we arrived in full Star Wars costumes to entertain the kids and their families. I’m dressed as Queen Amidala. Which brings me to the topic of today’s conversation. Can hairstyle impact your intubation or even your anesthetic management? The answer is yes. For example, there is no question that if Queen Amidala needed emergency intubation, that her hairstyle would get in the way. Read More …

Intubation With Airway Bleeding and Massive Emesis

During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? This article discusses two prior cases and offers suggestions on intubation when massive emesis or blood interfere with visualization. Read More …

Anticipated Difficult Intubation: Should I Intubate The Patient Awake?

When facing any intubation, you must decide whether the intubation is safer to be performed asleep or awake. Many providers are uncomfortable with performing awake intubations and leave it as a last resort. There are a variety of reasons for this discomfort, including lack of experience and/or the fear that the patient will remember the intubation and think poorly of their care. However, awake intubation can be a safe and comfortable strategy in many clinical situations. This article discusses some of the criteria for deciding when to do an awake intubation. Read More …

Avoiding Difficult Intubation Of The Easy Airway

We’ve all done it. It’s extremely easy to make any otherwise routine intubation difficult just by failing to properly position the patient or to use optimal technique. This article discusses the various ways you can adjust patient positioning and use your equipment to make intubation easy. Read More …

Positioning The Head For Intubation

This article discusses the different ways of placing the patient in the sniffing position and the advantages and disadvantages of each to improve first pass intubation success. Position of the head and neck for intubation can make intubation easy, or hard.
Many years ago our operating room administration Removed the towels we had been using to position the head for intubation. It may be an exaggeration to say that chaos ensued, but it felt like that.

For the next several days our anesthesia providers had trouble intubating. We likened it to an expert golfer who, when suddenly faced with a new set of golf clubs of slightly different weight and length, suddenly has to relearn the game. It made us realize that how we position the head in the sniffing position often sets us up for either an easy or for a more difficult intubation if you don’t realize what’s happening during the positioning. Read More …

Awake Intubation With The GlideScope

One of the most challenging scenarios to face is a tumor in the airway. Working closely with your surgeon is important. In these days of advanced technology, we often avoid awake intubate because of concern of causing the patient pain or distress. However, sometimes awake intubation is the safest way to proceed and if you are gentle and prepare the patient well, it can be comfortable as well. The Glidescope is another tool you can use for awake intubation. Read More …

Glidescope: Tricks For Successful Intubation

Glidescopes are very easy to use, but intubation with the Glidescope is very different than direct laryngoscopy. I have seen many novice Glidescope users struggle to intubate, despite having great views of the larynx. Failure to recognize the differences of using the Glidescope can make intubation not only frustrating but also hazardous to your patient. Beginners almost always make the same few easy to correct mistakes. This article discusses those mistakes and how to correct them. Read More …

The Bougie: Use Wisely To Avoid Rare But Serious Complications

One of the simplest and most valuable devices to help with a difficult intubation is the bougie. The primary use is a difficult intubation, when you cannot see the larynx well but are able to predict where the glottic opening should be based on anatomy. This article discusses techniques as well as potential complications. Bougies must be used with care to avoid patient injury. Read More …

Tips for Mastering the LMA Fastrach

The rare “can’t intubate-can’t ventilate” scenario is frightening. It’s important to master as many techniques as possible to prepare for this possibility. The LMA Fastrach is designed specifically designed to ventilate a patient intermittently during a prolonged intubation attempt. Knowing how to use this tool could potentially save a patient’s life. Using the Fastrach is not difficult. However, there are enough steps during intubation, as well as during safe removal of the device without accidental extubation, that can make it seem intimidating. In addition to some tips and tricks that make it work, you’ll find a link below to a video clip of intubating a patient with the Fastrach. Read More …