Healthcare and Medicine Reference
Figure 15.6 Gum elastic bougie: this device is used when the vocal cords
are diffi cult to visualise completely. It is inserted through the cords and then
the tracheal tube railroaded over it.
Figure 15.8 Intubating laryngeal mask airway (LMA): a modifi cation of the
original LMA through which an endotracheal tube can be passed blindly. The
position of the mask cuff above the glottis when placed correctly acts as a
conduit to the vocal cords.
Box 15.1 Equipment required for intubation
Laryngoscope with selection of blades and spare batteries.
A selection of ET tubes.
Water-soluble jelly to lubricate the cuff to aid passage through
Tape to secure the tube in position.
A stethoscope to confi rm the correct placement of the tube.
Suction apparatus should be available in case of regurgitation.
Intubation aids: gum elastic bougie and stylet.
A selection of oropharyngeal airways and laryngeal mask airways.
A means of detecting expired CO
2 should be used to confi rm
correct tube placement.
The intubation attempt should only take 30 seconds before
re-oxygenating the patient.
Position: the neck is fl exed slightly and the head extended to pro-
duce the classic 'sniffi ng the morning air position.' A pillow is
placed under the head (Figure 15.9).
Insert the laryngoscope: the laryngoscope is held in the left hand.
Figure 15.7 Fibreoptic laryngoscope: this device is used to visualise the
patient's airway. A tracheal tube can be railroaded on to the scope and
advanced off it once the vocal cords have been passed.
Introduce it gently at the right side of the mouth over the tongue.
Important landmarks must be identifi ed when advancing
the laryngoscope into its correct position in the vallecula (see
Box 15.2 & Figures 15.10, 15.11a).
With the blade of the laryngoscope in the vallecula, lift upwards
bougie (Figure 15.6), the fi breoptic laryngoscope (Figure 15.7) and
the intubation laryngeal mask airway (iLMA) (Figure 15.8).
Step-by-step guide: orotracheal intubation
Prepare your equipment as per Box 15.1.
Preoxygenate the patient: intubation should be preceded
along the line of the laryngoscope handle, avoiding pivoting
on the upper teeth (Figure 15.11b). This lifts the epiglottis and
should reveal the vocal cords. These are whitish in colour with
their apex anteriorly (Figure 15.12).
by ventilation with the highest oxygen concentration possible.