The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP

Disclosures

Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Fiberoptic Intubation

The fiberoptic scope (see previously) can be used in the unanticipated difficult airway but only if it is readily available and the operator is skilled.[7,78,79] In this scenario, the oral route may be advantageous in terms of speed. Modified oral airways that also act as a bite guard may be helpful.[113] When the patient has been anesthetized, loss of muscle tone allows the epiglottis and tongue to fall back against the posterior pharyngeal wall. The jaw may need to be lifted forward to gain optimal visualization of the vocal cords.[79,92] Intubation can also be accomplished with a video laryngoscope[114] in which the view from the end of the laryngoscope is transmitted fiberoptically to a monitor screen. The screen displays the larynx and the ETT as the latter is advanced to the correct position.

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