Tracheal intubation

The airway can be maintained by equipment such as a face mask (with or without an oral airway) a laryngeal mask airway (LMA), Proseal LMA or a Combitube. However, the airway is not completely isolated from the oesophagus, and is therefore not secure from the risk of soiling by stomach contents, blood or secretions. The best method of securing the airway is passing a tube into the trachea (i.e. tracheal intubation) a skill central to the practice of anaesthesia. This article describes some of the conditions that may alert the anaesthetist to a possible difficulty during intubation, the tests that may help predict such scenarios, and what to do when faced with a patient who is difficult to intubate. A practical approach to direct laryngoscopy and to awake fibre-optic intubation is outlined.