Laryngoscopic Intubation: Learning and Performance

Image courtesy of Dr James DuCanto

This open access article describes a study of novices learning direct larygnoscopy for intubation in an anaesthesia setting.

Laryngoscopic Intubation: Learning and Performance

Take home points:

• It takes 50 + successful intubation attempts before >90% success rate is achieved in novices.
• The following factors determine success : number of attempts, insertion of larygnoscope, lifting of laryngoscope and asking for help
• Successful insertion of laryngoscopes doubled your chance of successful intubation

Tips to successfully insert a direct laryngoscope:

1. If time permits, assess mouth opening. You might be surprised that mouth opening is terrible! You then need to reconsider your intubation plan! An awake intubation may now be preferable!
2. Check dentition. Disfigured teeth pointing in different directions will impede successful insertion of laryngoscope/device. If you typically insert blade in midline, it may mean you need to change your insertion point laterally.
3. Consider shielding the teeth with custom guards or gauze pads. THis helps you not get distracted by concern for injuring the dentition during insertion
4. Consider using an instrument to open the mouth. A spatula, a suction device. Dr DuCanto has described using a Jennings mouth gag here

Comprehensive setup for airway tumor obstruction presenting for urgent Trach, needs ETT first pic.twitter.com/QIImXjYVHr

— James DuCanto (@jducanto) January 30, 2015