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Infraglottic airway devices and techniques

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Airway management involves far more than just proficiency with tracheal intubation techniques. There are several infraglottic techniques available and the method chosen will depend on the accessibility of equipment, the level of training and expertise, and the patient's specific injury or disease.

Endotracheal intubation is most commonly performed by direct laryngoscopy. Several modifications of laryngoscope blades and a variety of adjuncts such as bougies may help to accomplish even a difficult airway.

Rigid intubation fibrescopes do improve the view of the larynx, especially in patients with difficult anatomy. They also permit tracheal intubation with less head and cervical spine movement than is often generated by direct laryngoscopy. Successful intubation, however, requires considerable experience, as in intubation techniques using flexible fibrescopes.

Both the EasyTube and the Combitube serve as an infraglottic or a supraglottic airway. The tip of the EasyTube resembles the one of an endotracheal tube, whereas the Combitube is much more bulky.

Section snippets

Endotracheal intubation

Endotracheal intubation is the most common technique for securing the airway. It provides best protection against aspiration of foreign material1 and is commonly used in anaesthesia, emergency medicine and intensive care.

The introduction of a cuff-sealed endotracheal tube through the mouth or nose into the trachea offers significant advantages over other techniques, especially for the treatment of patients in critical condition (Table 1).

The cuffed endotracheal tube effectively seals the

EasyTube

The EasyTube (EzT) was developed for in-hospital and pre-hospital use in all patients with anticipated or unanticipated airway difficulties. It is a disposable device that combines the essential features of an endotracheal tube with those of a supraglottic airway.31

It consists of two lumens that allow ventilation with the tip of the tube in either the tracheal or the oesophageal position. A large oropharyngeal cuff ensures an airtight seal to the oro- and nasopharynx. The tip of the tube

Oesophageal tracheal combitube

The oesophageal–tracheal Combitube (ETC) was developed primarily as an emergency tube for ventilating patients during resuscitation.32, 33 It has two lumens, one of which resembles a conventional endotracheal tube while the other seals off the oesophagus with an oropharyngeal balloon (Figure 10).

The device is designed to ventilate the lungs depending on the positioning of the distal end (either oesophagus or trachea). The tip can be inserted into the trachea, although it has a diameter of 41

Summary

Infraglottic airway management techniques, such as intubation of the trachea with a cuff-sealed endotracheal tube, offer significant advantages for the anaesthetized patient, especially for patients in critical condition.

There are numerous ways of intubation of the trachea; the most common and popular is direct laryngoscopy. The variety of laryngoscope blades offers choices to solve difficult intubations, but all different techniques and devices need experience in routine clinical use.

In case

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    The author's institution received research grants from Ruesch/Teleflex Medical, Germany, and Karl Storz, Germany.

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