How to Do Orotracheal Intubation Using Laryngoscopy

Aug 30, 2023 Ultrassist

Laryngoscopy is a medical procedure used to visualize the larynx (voice box) and the vocal cords. It is commonly performed to facilitate endotracheal intubation, which is the insertion of a breathing tube into the trachea (windpipe) to establish an airway for patients undergoing surgery or those who require mechanical ventilation. There are mainly two types of laryngoscopy: direct laryngoscopy and video laryngoscopy.

Direct Laryngoscopy:

In direct laryngoscopy, a laryngoscope is used to directly visualize the larynx and vocal cords. There are different blade designs used in direct laryngoscopy, and the most commonly used ones are the Macintosh and Miller blades.

Macintosh Blade: This is a curved blade that is placed in the vallecula (the space between the base of the tongue and epiglottis) to lift the epiglottis and visualize the vocal cords.

Miller Blade: This blade is straight and is often used when there's limited space or difficult airway anatomy. It's inserted under the epiglottis to lift it and expose the vocal cords.

Video Laryngoscopy:

Video laryngoscopy involves the use of a camera or fiber-optic system attached to the laryngoscope, which provides a visual display of the airway on a screen. This allows for better visualization, especially in cases where direct line-of-sight is challenging.

When performing laryngoscopy for intubation, proper technique, and hand placement are crucial to ensure a successful and safe procedure. Here's how to hold the laryngoscope for intubation.

How to hold a laryngoscope for intubation?

To hold a laryngoscope for intubation, grasp the handle with your left hand (if right-handed), place your thumb on the lower surface for leverage, and insert the blade into the right side of the patient's mouth, sweeping the tongue to the left for optimal visualization of the vocal cords.

1. Positioning:

Make sure the patient is properly positioned, with their head extended at the atlanto-occipital joint and their neck aligned for optimal airway visualization.

2. Blade Insertion:

Hold the laryngoscope in your left hand if you're right-handed (or vice versa). Your thumb should rest on the blade's control button.
Insert the laryngoscope blade into the patient's mouth, gently sweeping the tongue aside. Avoid pushing down on the soft tissues to minimize trauma.

3. Laryngeal Exposure:

Lift the laryngoscope blade gently, using the tip to lift the epiglottis (Macintosh) or slide under the epiglottis (Miller) to expose the vocal cords.
Maintain a gentle upward and slightly forward pressure to create a clear line of sight to the vocal cords.

4. Intubation:

Once the vocal cords are visible, insert the endotracheal tube through the vocal cords into the trachea.
Watch the tube pass through the vocal cords and into the trachea as you advance it.
Confirm proper tube placement through clinical signs (chest rise, auscultation, capnography, etc.).

Remember, successful intubation requires practice and familiarity with the equipment. In difficult cases, when visualization is challenging, it's important to have backup plans and experienced personnel available.

Refer to: Practice Intubation with Infant Manikin and Laryngoscope

Always ensure patient safety, and if you're not a trained medical professional, do not attempt these procedures without proper training and supervision.