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1、IndicationsandContraindicationsAnyclinicalsituationinwhichadefinitiveairwayisnecessaryandlimitedneckmotionispermissibleisanindicationfororotrachealintubation.Manyofthesesituations,includingcardiacarrest,airwaycompromiseininfectionandtrauma,andairwayobstructionarediscussedi
2、ndetailinChapter1.Mostorotrachealintubationsareaccomplishedusingadirectlaryngoscope.Anunstablecervicalspineinjuryisarelativecontraindicationtodirectlaryngoscopy.EquipmentLaryngoscopeFacilityintheuseofthedirectlaryngoscopeisaprerequisitefororotrachealintubation.Variousadult
3、andpediatricbladesizesareavailable.Therearetwobasicbladedesigns--curved(MacIntosh)andstraight(MillerandWisconsin).Slightvariationsinlaryngoscopictechniquefollowfromone'schoiceofbladedesign,whichisoftenamatterofpersonalpreference.Thetipofthestraightbladegoesundertheepiglott
4、isandliftsitdirectly,whereasthecurvedbladefitsintothevalleculaandindirectlyliftstheepiglottisviathehyoepiglotticligamenttoexposethelarynx.SpecialbladesdesignedfortheanteriorlarynxincludetheSikerandtheBelscope(AvulungaPtyLtd,NewSouthWales,Australia).Eachbladetypehasadvantag
5、esanddisadvantages.Thestraightbladeisusuallyabetterchoiceinpediatricpatients,inpatientswithananteriorlarynxoralongfloppyepiglottis,andinindividualswhoselarynxisfixedbyscartissue.Itislesseffective,however,inpatientswithprominentupperteeth,anditismorelikelytobreakteeth.Useof
6、thestraightbladeisalsomoreoftenassociatedwithlaryngospasmduetoitsstimulationofthesuperiorlaryngealnerve,whichinnervatestheundersurfaceoftheepiglottis.Astraightblademayinadvertentlybeadvancedintotheesophagusandinitiallypresentonewithunfamiliaranatomyuntilitiswithdrawn.Thebl
7、adehasalightbulbatthetipthatmayslightlyhampervision.Thewider,curvedbladesarehelpfulinkeepingthetongueretractedfromthefieldofvision,allowingformoreroominpassingthetubeintheoropharynx,andtheyaregenerallypreferredinuncomplicatedadultintubations.Asidefrompatientconsiderations,
8、someclinicianspreferthecurvedbladebecausetheyfinditrequireslessforearmstrengththanthestra
