Easy Intubation

This is a routine easy intubation. After the operator is able sweep the tongue, the operator is able to obtain a CL Grade 1 view and the pass the ETT. A mackintosh blade is used. Since the curved laryngoscope was used, the operator placed the blade tip in the vallecula and applied firm, steady upward pressure at a 45-degree angle to lift the epiglottis to visualize the VC.

Another easy intubation. The operator does a good job sweeping the tongue to the left side and so no tongue is visualized. The epiglottis is seen. The operator initially engages the blade at the vallecula, later engages the tip of the blade underneath the epiglottis. The latter method is usually performed using a straight blade and in pediatric population who has a long and narrow epiglottis. Both techniques can be used to get a better view.

In this intubation, the operator is able to see the epiglottis but unable to visualize the VC initially. This is overcome by lifting the blade up forward with and upward with a higher force. The CL grade improved from grade 3 to 2 using this maneuver. Alternatively the “BURP” maneuver can be used which consists of displacement of larynx in 3 specific directions: Backward (posteriorly against the cervical vertebra), Upwards (superiorly) and Rightward Pressure.
Fogging is not an uncommon problem encountered while using a VL.

Here the operator placed the blade too deep to see the esophagus, later retract slowly until the VC and seen.
A reinforced or flexometallic tube is used here (identified by the presence of spiral wire seen inside the ETT).

This is a routine intubation using a double lumen tube (DLT). The DLT is identified by the dark blue cuff of the tube. DLT has a special curvature, occasionally making its placement difficult. In this video, the operator finds it difficult to pass the DLT beyond the VC initially and is able to pass after the trajectory is corrected. Once the dark blue bronchial cuff is passed beyond the VC, the DLT is turned 90 degrees and advanced until the transparent tracheal cuff passes the VC.

Upon laryngoscopy, we can see the feeding tube passing from the nasopharynx to the esophagus. The operator suctions the thick secretions before proceeding. Thick secretions are common in patients who have been in the ICU for a long time. Once the glottis is clear, the ETT is passed easily. In the presence of fluid (secretions/ blood/ vomitus), visualization of the larynx is obliterated especially with a camera assisted intubation (VL or fiberoptic bronchoscope).