Transcript Non-Visual Intubation Techniques

Non-Visual Intubation
Techniques
Orlando Hung
Departments of Anesthesia, Surgery
and Pharmacology,
Dalhousie University
Halifax, Nova Scotia
Objectives
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Non-visual techniques
Light-guided intubation
Blind nasal intubation
Retrograde Intubation
Digital Intubation
Why Do We Need Non-visual
Intubation Techniques?
Why Do We Need non-visual
Intubation Techniques?
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Difficult laryngosopic intubation 1 – 3%
patients
Alternative techniques have been developed to
overcome this difficulties
Many of these techniques require expensive
equipment, and special skill and training.
Additionally, a lot of these techniques may be
difficult to employ in emergency situations, and
in patients with copious secretions, vomitus, or
blood in the oropharynx.
Would it not be safer to place a tracheal tube
using a technique that is under direct vision?
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In principle, the placement of an endotracheal
tube into the trachea under direct vision ought
to be safer.
Intubation is not always possible under vision.
Most procedures performed in medicine are in
fact blind techniques.
Tips to Enhance Oral Trachlight Intubation
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Positioning:
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head and neck neutral or extended
Adjusting ambient light and retracting chest tissues
for obese patients
Look for the “cone of light”
Limitations of Light-guided intubation
Blind Nasal Intubation
Nasal Intubation
Occasionally, to lift
the tip of the ETT
anteriorly, it is
necessary to inflate
the cuff with 20
mL of air
Retrograde Intubation
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In 1960, Drs. Butler and Cirillo reported the first
retrograde intubation in surgical patients through
an existing tracheostomy opening.
The technique was subsequently modified by
Waters who performed a cricothyroid membrane
puncture using a Touhy needle
Limitations of retrograde
Intubation
The major difficulty of the technique
relates to the inability in determining the
location of the tip of endotracheal tube
during intubation. In some situations, the
epidural catheter or guide-wire is removed
even though the tip of the tube is
mistakenly placed in the vallecula.
Modifications of the Techniques
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Subcricoid puncture
Modifications of the Techniques
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Subcricoid puncture
Through the Murphy eye of ETT
Modifications of the Techniques
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Subcricoid puncture
Through the Murphy eye of ETT
Pull through using a silk suture
Modifications of the Techniques
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Subcricoid puncture
Through the Murphy eye of ETT
Pull through using a silk suture
Flexible bronchoscope
Modifications of the Techniques
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Subcricoid puncture
Through the Murphy eye of ETT
Pull through using a silk suture
Flexible bronchoscope
Light-guided using transillumination
Limitations of Retrograde Intubation
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Any situation that makes it difficult to
perform a cricothyrotomy will also be
difficult to perform a retrograde
intubation.
Digital intubation
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Tactile digital intubation was probably first
described by Herholdt and Rafn in 1796.
Although digital intubation is seldom the
intubation technique of choice in modern
airway management, this technique can
be life-saving in some situations.
Summary
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Laryngoscopic intubation remains a challenge in a small
percentage of the population.
While many alternative techniques are available, they
are expensive and not particularly useful for emergency
situations with limited resources.
Non-visual intubating techniques can play an important
role in airway management.
Over the last several decades, these non-visual
techniques have been shown to be effective and safe in
securing an airway.
Non-Visual Intubation
Techniques
Orlando Hung
Departments of Anesthesia, Surgery
and Pharmacology,
Dalhousie University
Halifax, Nova Scotia