How to manage a difficult airway

The patient is not breathing. You attempt to intubate but there seems to be no space for the endotracheal tube (ETT). It bounces back or deflects upwards and repeatedly passes into the oesophagus. It will not pass into the trachea. The tongue is becoming cyanotic; you grasp it firmly and try to open the mouth wider, struggling to see inside. The clock is ticking. What can you do?

In order to provide safe anaesthesia, the anaesthetist must be able to maintain adequate respiratory function (Grimm et al, 2015). Part of this entails securing a clear airway and endotracheal intubation is probably the most effective way to do this. Endotracheal intubation is the process of placing an airway device (ETT) via the mouth into the trachea. This process not only helps to secure the airway, but also enables the delivery of oxygen and volatile anaesthetic agents, while facilitating effective scavenging of waste gases and reducing environmental contamination. Endotracheal intubation can also be used to facilitate positive pressure ventilation (PPV).