Alternatives to the Laryngoscope

Unfortunately, not all patients could be successfully intubated with the hand-held laryngoscope. Several new blades were developed in the 1940s and 1950s to solve the problem of the difficult airway, but none was 100% successful, and it soon became apparent that some airways could not be intubated with any hand-held instrument. In those cases, the few remaining members of the hospital staff who had been trained in blind tactile intubations were called in to secure the airway.

The problem of a difficult or impossible intubation is now solved with a variety of tools, including various modifications of the laryngeal mask airway (LMA) and the flexible laryngoscope, both established tools in the modern anesthesia department. The LMA was developed by A. J. Brain of the Royal Berkshire Hospital, Reading, England, with the commercial product first appearing in 1983.^[424] This device is well named, for it is indeed a small mask that covers the glottic opening. The LMA eliminates the need for tracheal intubation in many cases and is useful in managing the difficult airway.

The beginnings of flexible laryngoscopy were rooted in the 19th century. John Tyndall succeeded the more famous Michael Faraday as Superintendent of the Royal Institution in London in 1867 and published his observation in 1854 that light could follow a curved path through a water tube.^[425] In 1930, H. Lamm^[426] employed this property of light when he introduced the flexible gastroscope, using glass fibers instead of water. S. Ikeda^[427] transferred the same technology to a smaller-diameter instrument, introducing flexible bronchofiberoscopy in 1968. The definitive work followed in 1971.^[428]