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Recent years have seen a rapid expansion in optical devices used to aid in endotracheal intubation. All of these devices use fiberoptics that begin near the distal end and transmit an image to be viewed at the proximal end. Many of these devices are variations on the “optical stylet” concept. They consist of an eyepiece or other viewing mechanism attached to a stylet of varying degrees of flexibility. A standard endotracheal tube can be jacketed onto each device. The stylet can then be used as an adjunct to standard endotracheal intubation or as a stand-alone device.
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Traditional direct laryngoscopy requires alignment of the oral, pharyngeal, and laryngeal axes to visualize the glottis. Despite mechanical manipulation, it is not always possible to align these three axes. The major advantage of fiberoptic laryngoscopy devices is that they do not require the Emergency Physician to align the three airway axes, thus reducing the need for manipulation and potential traumatic forces on the airway. Fiberoptic devices provide a superior view of the glottis when compared to traditional direct laryngoscopy. The lens of these devices is within centimeters of the glottis and provides a wider angle of vision than the 15° of traditional direct laryngoscopy. The viewing port magnifies the view of the airway making structures easier to visualize.
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A generalized approach to using optical stylet-type devices will first be discussed, followed by the unique features of each selected instrument. This chapter reviews a representative number and types of devices currently available and used in Emergency Departments. The last two devices covered in the chapter, the Airtraq and Bullard laryngoscope, function quite differently than an optical stylet.
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Fiberoptic intubation devices can be used for adult and pediatric difficult (actual or anticipated), elective, emergent, and routine intubations. These devices can be used as “rescue devices” in cases of failed direct laryngoscopy. Patients with their head and neck immobilized, limited mouth opening, morbid obesity, or those requiring awake intubation or intubation while in a sitting position can benefit from intubation with these devices. It provides better visualization of the glottis, decreased cervical movement, and higher success rates in comparison to traditional direct laryngoscopy. These devices can be used to aid in the localization and removal of airway foreign bodies. There are no contraindications to the use of these devices.
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There are some general guidelines to using fiberoptic intubation devices that will improve the Emergency Physician's success in their implementation. First, it is useful to understand the limitation of these devices. Fogging is a common problem. Fogging can be minimized by applying a medical grade antifog solution to the lighted end of the instrument or warming the distal tip by placing it in a warm blanket or warmed saline solution. Any fluid (e.g., blood, secretions, or vomitus) in the oropharynx will limit the usefulness of these devices. First, suction any fluid and debris from the oropharynx prior to device insertion. Second, care should ...