When emergency intubation was first introduced in the 1880s by Jopseph O’Dwyer it was performed blindly using the fingers to palpate the larynx and direct the Endotracheal tube into the airway. Diphtheria an acute bacterial infection spread by personal contact, was the most feared of all childhood diseases. One child out of every ten that became infected died from this disease. Symptoms ranged from a severe sore throat to suffocation by the formation of a 'false membrane' over the larynx. Between 1880 and 1887, Joseph O'Dwyer devised a series of tubes to be inserted into the larnyx and thus maintain air supply until the crisis period of the illness passed. O'Dwyer's intubation tubes were not foolproof, nor simple to use, but desperate doctors and parents grasped this innovation as a precious last resort. The American medical community hailed O'Dwyer as the medical savior of thousands of children in the United States. In 1913 Henry Janeway developed a laryngoscope designed for the sole purpose of allowing the anesthesiologist to place an intratracheal conduit with consistent success to help alleviate these concerns. The speculum Janeway designed incorporated a distal light source with battery power within the laryngoscope handle itself. This handle-inclusive battery power was the first of its type. Additional features included a shortened distal end of the speculum that eliminated the need for a telescope to adequately view the larynx, a central notch for maintaining the catheter in the midline during placement, and a curve to the distal end of the blade to help direct the catheter through the vocal cords. Guedel, on the other hand, used a folding laryngoscope blade and light source for ease in transport from one anesthetizing location to another because a rigid laryngoscope was less well-suited for transport from one hospital to another. Today, most intubations worldwide are performed using technology that was developed over almost 70 years ago. Unfortunately, there are patients who cannot be intubated with a co n ventional laryngoscope because a direct line of sight cannot be achieved from the physician’s eyes to the larynx. In recent years, severall investigators have developed novel devices that incorporate video and optical technology to augment the function of the laryngoscope.
Group of anesthesiologists from the University of Geneva, Switserland 60 anesthesia providers (staff anaesthesists, residents and nurses); experience: ≥50 direct laryngoscopies. Scenario 1: Pharyngeal obstruction Scenario 2: Pharyngeal obstruction and cervical spine rigidity Scenario 3: Tongue oedema
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