This open access article describes a study of novices learning direct larygnoscopy for intubation in an anaesthesia setting.
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:
- 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!
- 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.
- Consider shielding the teeth with custom guards or gauze pads. THis helps you not get distracted by concern for injuring the dentition during insertion
- 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