MAY 2, 2022

Current Concepts In the Management of The Difficult Airway

Volume 19, Number 1

Carin A. Hagberg, MD, FASA

Chief Academic Officer
Division Head, Division of Anesthesiology, Critical Care, and Pain Medicine
Bud Johnson Clinical Distinguished Chair
Department of Anesthesiology and Perioperative Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Immediate Past Executive Director, Society for Airway Management

Hagberg reported grant support from Ambu, KARL STORZ Endoscopy and Vyaire Medical.

Editor’s note: A key of abbreviations and acronyms appears below the tables.

This edition of “Current Concepts in the Management of the Difficult Airway” marks the 19th anniversary of this biannual review of airway devices and techniques that are currently available to manage both routine and difficult airways, regardless of setting.

Management of the difficult airway remains one of the most relevant and challenging clinical situations encountered by anesthesia practitioners, as major adverse consequences can occur if the airway is not secured in a timely fashion. Most airway problems can be solved with relatively simple devices and techniques, but clinical judgment born of experience is crucial to their application. As with any intubation technique, practice and routine use will improve performance and may reduce the likelihood of complications. Each airway device has unique properties that may be advantageous in certain situations, yet limiting in others. Specific airway management techniques are greatly influenced by individual disease and anatomy, and successful management may require combinations of devices and techniques.

Name (manufacturer)	Description	Length	Clinical applications	Special features
Table 1. Endotracheal Tube Guides
Aintree Intubation Catheter (Cook Medical)	Polyethylene 19 Fr AEC allows passage of a FIS through its lumen. Has two distal side holes and is packaged with Rapi-Fit adapters. Includes a bronchoscope port. Color: light blue.	56 cm.	Exchange of SGAs for ETTs =7.0 mm using a FIS. Its hollow lumen allows insertion of a FIS directly through the catheter so that the airway can be indirectly visualized.	Large lumen (4.7 mm) allows passage of a maximum OD 4.2 mm FIS. Rapi-Fit adapters allow both jet ventilation and ventilation with 15-mm adapter (anesthesia circuit or Ambu bag). Two distal side ports. Single use.
Arndt Airway Exchange Catheter Set (Cook Medical)	Polyethylene 14 Fr AEC with a tapered end, multiple side ports, packaged with a stiff guide wire, a double swivel bronchoscope connector, bronchoscope port and Rapi-Fit adapters. Color: yellow.	Wire: 160 cm. AEC: 70 cm. For insertion of =5.0 mm ETTs.	Exchange of LMAs and ETTs using a FIS.	Tapered end and distal multiple side ports. Rapi-Fit adapters allow both jet ventilation and ventilation with 15-mm adapter (anesthesia circuit or Ambu bag). Single use. The 160 cm–long wire can be inserted through the working channel of the FIS.
bébé Vie Scope (Adroit Surgical)	The bébé Vie is a one-size pediatric laryngoscope. It is used similarly to the Vie Scope but an age- appropriate ETT is passed directly through the vocal cords using a straight line of sight. The unique blade design facilitates both blade insertion into the vallecula or elevation of the epiglottis.	One size fits most pediatric patients.	The bébé Vie can be used in any pediatric difficult airway, including critically ill pediatric patients.	The bébé Vie has a large right-sided slot for ETT insertion and a long rubber tooth guard built in. Proximally positioned LEDs illuminate the entire length of the blade similar to the Vie Scope.
Cobra Introducer (Occam Design)	15 Fr airway intubation guide with telescoping extension. Coudé tip and three side holes. Color: orange.	60 cm (73 cm when telescopically extended).	Facilitates tracheal intubation, especially in situations of difficult airway anatomy. Facilitates both DL and VL. Works as a traditional bougie, then additionally extendable while in use, when desired.	Telescoping segment to enhance glottis entry. Malleable, reversible, and controllable from middle or either end.
Cobralet (Occam Design)	15 Fr airway intubation guide with hollow interior channel. Color: orange.	60 cm.	Facilitates tracheal intubation.	Malleable, hollow interior for O₂ insufflation.
Cook Airway Exchange Catheter (Cook Medical)	8, 11, 14 and 19 Fr polyethylene design facilitates exchange for single-lumen ETTs. Color: yellow.	8 Fr: 45 cm. Other sizes: 83 cm. For exchange of ETTs with ID mm: 8 Fr =3.0 mm; 11 Fr: =4.0 mm; 14 Fr: =5.0 mm.; 19 Fr: =7.0 mm.	The Cook AEC is intended for uncomplicated, atraumatic ETT exchange for both single-lumen tubes.	Rapi-Fit adapters as above, but should be used primarily for jet ventilation because of length. Two distal side ports. Single use.
Cook Airway Exchange Catheter Extra-Firm with Soft Tip (Cook Medical)	11 and 14 Fr polyethylene designs facilitate exchange of single-lumen or EF with soft tip. Color: green catheter; soft tip is purple.	100 cm. For exchange of ETTs/DLTs with ID minimum: 11 Fr: =4.0 mm. 14 Fr: =5.0 mm.	The Cook AEC EF soft tip is intended for uncomplicated, atraumatic ETT exchange for both single-lumen tubes and DLTs.	Rapi-Fit adapters as above, but should be used primarily for jet ventilation because of length. The soft-tip version offers a more flexible tip to help minimize tracheal trauma and the additional length Is compatible with DLT exchange. Two distal side ports. Single use.
Cook Staged Extubation Set (Cook Medical)	Soft-tipped marked extubation wire to maintain continuous airway access, wire holder and Tegaderm for securement, soft-tipped Reintubation Catheter, Rapi-Fit adapters to assist in O₂ delivery, if necessary. Available outside of United States only.	Wire: 145 cm. AEC: 83 cm.	Provides a tool for a more complete extubation strategy, which should be in place for every patient. ETTs >5.0 mm ID.	Uses an atraumatic wire to maintain continuous airway access and a soft-tipped reintubation catheter to facilitate a successful reintubation if required and delivery of O₂ when desired. Rapi-Fit adapters allow both jet ventilation and ventilation with 15-mm adapter (anesthesia circuit or Ambu bag). Multiple distal side ports. Single use.
CoPilot VL Disposable Bougie (Dilon Technologies)	14 Fr polyethylene single-use ETT introducer with coudé tip. Color: orange.	60 cm (ETTs =6.0 mm).	Facilitates tracheal intubation. Also may be used for tube exchange.	Single use.
CoPilot VL Rigid Intubation Stylet (Dilon Technologies)	Reusable CoPilot VL intubation stylet.	ETTs =6.0 mm ID.	Reusable CoPilot VL intubation stylet for use with VL to facilitate ETT placement.	Reusable, easy to high level disinfect or sterilize.
D-BLADE Reusable Stylet (KARL STORZ)	Reusable stylet designed especially for the C-MAC reusable and single-use adult D-BLADE. Individually peel-packed in boxes of 10.	31 cm; diameter shaft: 3-mm tip: 5 mm ID (ETTs =5.5 mm).	The angle of the D-BLADE reusable stylet complements the angle of the C-MAC D-BLADE laryngoscope to help facilitate placement of an ETT. The preshaped stylet improves maneuverability of the ETT toward the target.	Sateen finish allows the stylet to pass more easily into ETTs. Packaged ready to use; no reprocessing necessary for first use.
ETT Exchanger (Instrumentation Industries)	Single use. Rigid yet flexible with rounded tip and graduated marks for easy placement. Available in nine sizes from 2.5 mm to 7.5 mm ID.	Nine sizes (15- to 29-inch lengths).	Facilitates simple ETT exchange.	Specific exchanger for each ETT.
Flexible Tip Bougie (Sharn Anesthesia)	Steerable ETT introducer with soft, flexible and controllable tip. Ideal when there is a great view but advancing the ETT is still a problem.	65 cm, 15 Fr (ETTs =7.0 mm).	Useful with DL or VL, single-use Flexible Tip Bougie facilitates ETT placement and is particularly helpful when advancement of the airway or a traditional bougie is difficult. Helpful with anterior airway or when tracheal tumors are present and have to be navigated past.	Sliding “tabs” are moved with user’s thumb to flex or retroflex the tip to maneuver around the anatomy. Phosphorus tip for improved visualization under UV illuminated laryngoscopy. Useful with DL and VL.
Frova Intubating Introducer (Cook Medical)	Polyurethane 8.0 and polyethylene 14 Fr malleable introducer with curved distal tip with two side ports. Has hollow lumen and is packaged with a stiffening cannula and removable Rapi-Fit adapters. 14 Fr also available, individually sterile packaged in box of 10, catheter only without stiffening cannula. Colors: 8 Fr, yellow; 14 Fr, blue.	8 Fr: 35 cm. 14 Fr: 70 cm.	Facilitates tracheal intubation; not intended for ETT exchange. Also can be used by placing it first in the ETT, with its tip protruding, or placing it directly into the glottis and then placing the ETT over it. Used straight or slightly curved with DL or definitively curved with VL.	Blunt, angled tip, two distal side ports. Rapi-Fit adapters allow both jet ventilation and ventilation with 15-mm adapter (anesthesia circuit or Ambu bag). Hollow lumen allows oxygenation/ventilation/CO₂ detection in all sizes. Single use.
GlideRite Single-Use Stylets (Verathon)	Designed for use with hyperangulated GVL and help facilitate placement of ETT.	Large: ETTs =6.0 mm. Medium: ETTs 4.5-5.5 mm. Small: ETTs 3.0 mm, 4.0 mm.	For use with hyperangulated GVL. Rigid, preformed design enhances ETT control during intubation.	Sterile, individually packaged (sold in boxes of 10). Large and medium size: easy-to-use handle design for simple ETT securement and stylet removal. Small size: adjustable stopper. Single use.
GlideRite Reusable Stylets (Verathon)	Same as GlideRite Single-Use Stylets.	ETTs and DLTs =6.0 mm.	Both: For use with hyperangulated GVL. Rigid preformed design enhances ETT control during Intubation. DLT stylet: for use with DLTs.	Both: Reusable. Compatible with high-level disinfectants, autoclave and other sterilization methods. Easy-to-use handle design for simple ETT securement and stylet removal. DLT stylet: integrated tracheal lumen positioning pin.
i-Bougie (VBM)	Single-use 14 Fr introducer with angled tip and hollow lumen for oxygenation. Color: orange.	70 cm.	Facilitates tracheal intubation. Low friction material is shapeable and allows easy tube passage.	Supplied with two types of O₂ connectors to allow oxygenation through the lateral openings at the tip.
Insighter Rigid Stylet (Bell Medical)	Reusable and sterilizable. Designed to work with GVL, C-MAC and Insight VL, or any other VL.	34 cm 3.8 OD (ETTs =4.5 mm).	Preformed curve matches that of Insight VL, GlideScope and C-MAC.	Reusable, durable stainless steel; easy to clean and sterilize.
Introes Pocket Bougie (BOMImed)	Single-use 14 Fr (4.7 mm) malleable ETT introducer made from special blend of Teflon (Chemours). Packaged in box of 10.	60 cm (ETTs =5.0 mm).	Designed to facilitate both DL and VL tracheal intubation. Unique curvature designed to follow natural path of the airway. Flexibility: Customizable coudé tip angles allow for manipulation of the distal tip for anterior airways.	Self-lubricated bougie, tactiglide technology for tactile sensation, optimal curve with shape memory, balanced rigidity with soft-tissue protection, depth markings, packaged sterile.
IRRIS IR and Amber (Guide In Medical Ltd.)	IRRIS Amber infrared device is based on an electronic illumination patch, which is placed on the patient’s neck. IRRIS transmits light of a specific wavelength at specific density and frequency into the subglottic space, which guides the user for ETT placement.		Guides intubation in both routine and difficult airway situations by light identification of the subglottic space. Suitable for hospital and pre-hospital use.	Device is externally placed over cricothyroid membrane and adheres to the skin. Light emitted through the neck tissue to illuminate the subglottic space, which assists in identifying the trachea and vocal cords.
Obturating Introducer for Nasal ETT (Genesis Airway Innovations)	ETT introducer/dilator for nasal endotracheal intubation.	For sizes ID 5-8 mm Genesis Airway ETT with posterior-facing bevels.	Atraumatic nasal intubation. Posterior-facing bevel of ETT assists with first-pass intubation and reducing hang-up on anterior tracheal wall.	Tapered soft silicone introducer inserts into the lumen of and mates with the tip of an ETT, avoiding an increase to the external diameter of the complex, thus increasing the risk for nasal trauma. No soiling of the lumen of the ETT during nasal passage.
Pocket Introducer (VBM)	Single-use 15 Fr Introducer with coudé tip. Color: blue.	65 cm.	Facilitates tracheal intubation.	Folded to only 20 cm, unfolds to 65 cm within seconds; ideal space solution for emergency bags.
Portex Single-Use Bougie (Smiths Medical)	15 Fr, PVC ETT introducer with coudé tip. Has a hollow lumen that discourages reuse and is provided sterile. Color: ivory.	70 cm.	Single-use product reduces risk for cross-contamination. Otherwise, same as Portex Venn Tracheal Tube Introducer.	Similar to Portex Venn Tracheal Tube Introducer, but hollow lumen allows oxygenation/ventilation. Single use.
Portex Tracheal Tube Introducer (Smiths Medical)	15 Fr ETT introducer made from a woven polyester base, with a coudé tip (angled 35 degrees at its distal end). Also known as the gum elastic bougie. Color: golden brown.	60 cm.	Proven useful in patients with an anterior larynx (grades 2b, 3 and 4) and those with limited mouth opening. Can be used by slightly protruding through the ETT or placing directly into the glottis and then placing an ETT over it.	Nondisposable and reusable. Size 5.0 Fr is single use. Has memory properties. Coudé tip effectively detects “tracheal clicks” to confirm correct placement. Part of a range of introducers, stylets and guides for adults and pediatrics. Can be reused after cold-water disinfection.
Rhinoguard (Davis Medical)	ETT introducer/dilator.	25.4 cm: small for ETTs 3.0-4.5 mm; 35.5 cm: large for ETTs 5.0-8.0 mm.	Facilitates nasal intubation.	Optimized longitudinal stiffness to facilitate passage of an ETT, especially in challenging nasal passages. Customized for 3.0-8.0 ETTs. Optimal OD taper provides ability to utilize larger ETT, if desired.
RPiS, Rapid Positioning Intubation Stylet (Airway Management Enterprises)	Single-use flexible stylet with tip that allows 180-degree flexion and retroflexion. Tip protrudes 5 cm from the end of ETT. Color: blue.	38 cm (ETTs =6.0 mm).	Provides greater visibility and control of tip similar to a FIS (with one provider) in difficult and routine intubation with VL.	Single-use stylet with atraumatic soft tip.
S-Guide (VBM)	Single-use 15 Fr, 11 Fr and 8 Fr stylet, malleable, with atraumatic coudé tip and hollow for oxygenation (only 15 Fr and 11 Fr).	65 cm.	Difficult intubation. Ideal for non-channeled VL.	Malleable stylet with color-coded soft tip. Supplied with two types of O₂ connectors to allow oxygenation (only 15 Fr and 11 Fr).
Runnels Dynamic Introducer, TCI-Si (Through the Cords)	Dynamic ETT introducer allows dynamic navigation and precision tracheal access. Ideal for use with any non-channeled VL.	(ETTs =6.0 mm).	Provides single-handed dynamic navigation into the trachea under visualization with VL or DL, difficult intubations, single-operator rescue after failed VL or DL with standard nondynamic introducers or stylets. Allows a single-operator combined technique using VL for visualization and dynamic introducer for tracheal access.	Dynamic ETT introducer with articulating tip, prelubricated flexible shaft, no setup prior to use, removable pistol grip handle that controls tip articulation, compatible with any non-channeled VL blade. Single use.
VBM Tube Exchanger (VBM)	Single-use 11, 14 and 19 Fr tube exchanger that is hollow to allow oxygenation. Color: blue.	80 cm.	Exchange of ETTs.	Supplied with O₂ connector.
Vie Scope (Adroit Surgical)	Single-use, battery-powered, disposable scope that uses a closed circular tube with a beveled end to visualize the vocal cords.	Adult, one size fits all.	Allows for a straight line-of-sight view with 360 degrees maximal illumination to pass a bougie between the vocal cords. Provides the ability to intubate the patient when awake in trauma, routine and difficult situations both in the hospital and in the field.	Patented LED ring illumination located at the proximal end of a self-enclosed clear tube allows light to be transmitted through the lumen of the tube as well as the sidewall to avoid obstruction of light by secretions or blood. Single use.
Voir Bougie (Adroit Surgical)	Single-use 15 Fr polyethylene ETT introducer with formable tip. Colored safety bands: Light blue bougie with green and red safety depth marking bands gives the user immediate depth insertion distance for rapid intubation.	70 cm, 15 Fr (ETTs =6.0 mm).	Facilitates tracheal intubation and increases patient safety.	Clearly marked color bands (patent pending) permit the user to note the correct depth upon insertion to avoid lung or tracheal injury.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 2. Stylets
Lighted stylets
Aaron Surch-Lite (Apyx Medical)	10-inch sterile, single-use, flexible stylet.	Adult.	Usable for routine blind intubation or additional illumination during laryngoscopy, but especially useful when FIS unavailable (e.g., outside locations or ambulances), or when bronchoscopy is difficult to perform (e.g., obscured airway or limited head motion allowed).	Can be used alone or with other techniques. Completely disposable. Intended for single use. Individually packaged in boxes of three.
AincA Lighted VideoStylet (Anesthesia Associates)	Easily malleable, lighted stylet with adjustable ETT holder. Shapes and guides ETT while forwardly illuminating passage. Completely reusable device consisting of removable handle with xenon bulb.	Adult and pediatric (ETTs =5.0 mm). Infant (ETTs =3.0 mm).	Same as Aaron Surch-Lite.	Can be used alone or with other techniques. Handle-mounted xenon light source is always on and keeps stylet tip cold. Uses two AA batteries. System is completely reusable and sterilizable.
Tube-Stat Oral Intubation Stylet (Medtronic)	Similar to AincA Lighted VideoStylet.	Nasotracheal: 33 cm shaft. Orotracheal: 25 cm shaft.	Ideal for difficult intubation, teaching.	Minimizes neck flexion and head hyperextension in trauma cases.
Vital Signs Light Wand Illuminating Stylet (GE Healthcare)	Similar to AincA Lighted VideoStylet.	Adult.	Flexible lighted stylet for use with or without a laryngoscope. Especially useful in soiled or bloody airways.	Bright light provides excellent verification of ETT positioning, even during difficult intubation. ETT temperature will not rise above 428C (1088F).
Viewing optical stylets
AincA VideoStylet (Anesthesia Associates)	Easily malleable, video imaging stylet with built-in ETT holder. Shapes and guides ETT while forwardly illuminating the passage and providing full-color image. Completely reusable device consisting of removable VideoStylet and attached rechargeable LCD monitor.	Adult and pediatric (ETTs =6.0 mm).	Usable for routine intubation or video imaging during laryngoscopy, but especially useful when a FIS is unavailable (e.g., outside locations or ambulances), or when bronchoscopy is difficult to perform (e.g., obscured airway or limited head motion allowed).	Provides rapid learning curve due to similar standard ETT advancement techniques, but with added benefit of an attached, clear video image of all landmarks forward of ETT tip. Allows for single-handed use with imaging or used in conjunction with a laryngoscope, as desired for physical alignment. Reusable system. Sterilized by glutaraldehyde, and Sterrad or Steris hydrogen peroxide systems.
C-MAC Video Stylet (KARL STORZ)	A high-resolution chip at distal end of the endoscope. The tip can be angulated anteriorly by up to 90 degrees, which helps in the narrow conditions of the oral cavity. The patented active bend mechanism can be used with an attached ETT and supports at the same time the passive return. Intuitive handling with universal C-MAC System interface for C-MAC Monitor (8403 ZXK) and C-MAC PM (8403 XD).	With ETT adapter and suitable for ETT =6 mm.	Able to elevate a large, floppy epiglottis and navigate through the oropharynx of patients with excessive pharyngeal soft tissue, midline obstruction, limited mouth opening, or fragile veneers on incisors.	Adjustable distal tip to aid in intubating the most anterior airways. Becomes a highly portable device when connected to the C-MAC Pocket Monitor. Includes ETT adapter, in addition to adapter for fixation of ETTs and O₂ insufflation. Portable, rugged, and better maneuverability than flexible FIS.
Clarus Levitan (Clarus Medical)	Portable high-resolution fiber optics enclosed in a malleable stainless-steel stylet provide a view from the tip of ETT. Built-in tube stops to hold ETT in place with integral O₂ port for O₂ insufflation during intubation. Assist with DL/VL like regular stylet to provide an added view from the tip of the tube or can be used independently as an easier-to-learn, less expensive alternative to FIS. Also malleable to be used through intubating supraglottic ventilatory devices. Optional adapter uses smartphones to transform optics to video.	Adult (ETTs =5.5 mm).	Similar to Shikani and Clarus Video Stylet Scope. Originally designed as adjunct to DL for improved first-pass success. For easy intubation, it is used as a standard stylet; or, when faced with an unexpected grade 3 or 4 DL view, it offers additional view from “around the corner” via the tip of the tube for successful first-pass intubation. Also may be used as a stand-alone device as an alternative to FIS for awake (or anesthetized). See Clarus Video Stylet 3000V.	GreenLine laryngoscope handle or a Turbo LED can be used for light sources. Otherwise, similar to Clarus Video Stylet 3000V, but requires user to cut the ETT because it does not have a movable tube stop. Able to connect to an endoscopic tower monitor or a smartphone adapter to connect to a smartphone screen for video viewing. Portable and small enough to carry in airway bag/crash cart when FIS may not be readily available.
Clarus Pocket Scope (Clarus Medical)	Conveniently sized, easy-to-clean and cost-effective (reusable) flexible stylet that has a patented, deflected, nondirectable tip. Optional adapter uses smartphones to transform optics to video. Often used to confirm placement and patency of airways.	Adult (ETTs =4.0 mm).	Allows for visualization during intubation through ILMA or quick confirmation of SGA, DLT, or ETT placement/positioning patency. Also may be used prior to extubation.	Has been modified with a patented deflected tip for a view from the end of the device. Able to connect to an endoscopic tower monitor or a smartphone adapter to connect to a smartphone screen for video viewing.
Clarus Shikani (Clarus Medical)	Viewing stylet: high-resolution, stainless steel, malleable fiber-optic stylet. Has adjustable tube stop and integral O₂ port for O₂ insufflation. Assist with DL/VL like regular stylet to add a view from the tip of the tube. Or used independently as an easier-to-learn, less expensive alternative to bronchoscope. Also malleable for use through intubating supraglottic ventilatory devices. Optional adapter uses smartphones to transform optics to video.	Adult (ETTs =5.5 mm). Pediatric (ETTs 2.5-5.0 mm).	Similar to Clarus Video Stylet 3000V.	Comes in adult and pediatric sizes. Light source options are light cable, Turbo LED, or GreenLine laryngoscope handle with adapter. Otherwise, similar to Levitan Viewing Stylet.
Clarus Video Stylet 3000V (Clarus Medical)	Malleable rigid stylet scope with attached LCD screen and adjustable curve shape provides view from end of stylet; built-in tube stop to hold ETT in place with integral O₂ port for O₂ insufflation during intubation. Assist with DL/VL like regular stylet to provide view from the tip of the tube or used as independent device as an easier, less expensive alternative to FIS. Also malleable to be used through intubating supraglottic ventilatory devices.	5 mm OD; ETTs =5.5 mm.	Provides view from tip of the tube. Similar to Shikani and Levitan viewing stylets. Often used as a stand-alone device as an alternative to FIS for awake (or anesthetized) intubation. Provides access with limited mouth openings, anterior airways, radiation or ENT patients. Malleable stylet allows shaping to reduce cervical movement. Also may be used to intubate through a supraglottic airway or in checking placement of ETTs or SGAs.	Has the simple form of a standard stylet, plus the advantage of a fiber-optic view. Portable, rugged and able to lift tissue. Malleability allows for more universal use in multiple techniques and various airway situations. Red LED provides transillumination. Portable and small enough to carry in airway bag/crash cart when FIS may not be readily available.
Hugemed Video Lighted Stylet (Bell Medical)	Disposable and reusable options in sizes 3.0 mm, 3.9 mm, 5.0 mm with an adjustable ETT stop.	3.0 mm diameter 300 mm length, 3.9 mm, 5.0 mm, 380 mm length.	Facilitates tracheal intubation for adults and infants.	The 3.0 mm and 3.9 mm diameter stylets are malleable, and the 5.0 mm is rigid. Available in both reusable and disposable options. Display on stylet is reusable HD with 16 million pixels, > 400 lux illumination.
Insighter Lighted Video Stylet (Bell Medical)	Malleable rigid stylet video scope with attached HD video display and adjustable curve shape provides view from end of stylet; built-in tube stop to hold ETT in place with integral O₂ port for O₂ insufflation during intubation. New wireless or wired communication to the 13-inch HD iWorkstation. Color display.	34 cm; 3.8 mm OD (ETTs =4.5 mm).	Similar to Shikani and Clarus Video Stylet Scope. Used as a standard stylet and ideal for patients with reduced mouth opening ability.	Malleable stylet is a semirigid tube core that returns to original shape after use. HD display, ETT secure stop and O₂ insufflation allow recording of pictures and videos.
J-Wand (D-R Burton Healthcare Products)	Semirigid intubating stylet that can be used with both video and standard laryngoscopy equipment. Flexible angled introducer tip to facilitate ETT placement. Oxygenation port built into handle enables providers to perform apneic oxygenation techniques during intubation process.	Can be used with =6.0 mm ETT.	Can be used with both standard and VL equipment. Facilitates placement of ETT, especially in anterior airway. Can provide direct apneic O₂ delivery from the ETT during intubation.	Flexible, angled introducer tip and stylet design that mimics modern curved-blade VL. Apneic oxygenation port built into handle. Semirigid stainless steel support within ETT. Ergonomic design facilitates easy insertion and removal of the stylet. Disposable, single use.
J-Wand Advantage (D-R Burton Healthcare Products)	Semirigid intubating stylet (without the introducer tip) that can be used with both video and standard laryngoscopy equipment. Oxygenation port built into handle enables providers to perform apneic oxygenation techniques during intubation process.	Same as J-Wand.	Same as J-Wand.	Apneic oxygenation port built into handle. Semirigid stainless steel support within ETT. Ergonomic design facilitates easy insertion and removal of the stylet. Disposable, single use.
Safe-Cam Video-Stylet System (Medical Safe-Cam)	Single-use, malleable stylet with integrated camera at tip. Image is displayed via a monitor, a cable, or Wi-Fi on phone.	ID =6.5 mm (for adults); =2.5 mm for pediatrics.	Direct view during intubation, including placement and verification of optimal position during intubation and beyond; with adult and pediatric sizes. Indicated for use during routine or difficult intubation.	Optimal, clear image resolution, with malleability allows tube visualization throughout, without blind spots, and no more invasive than the ETT (as within tube at all times of normal operation).
SensaScope (Acutronic Medical Systems)	Hybrid S-shaped, semirigid fiber-optic intubation video stylet. Has a 3-cm steerable tip with video chip that can be flexed in sagittal plane 75 degrees in both directions with lever at proximal end of device. No working channel.	Adult (ETTs =6.5 mm).	Able to elevate a large, floppy epiglottis and navigate through the oropharynx of patients with excessive pharyngeal soft tissue, midline obstruction, limited mouth opening, or fragile veneers on incisors.	Offers improved view of glottis, simultaneous direct and endoscopic views, full visual control over passage of ETT and confirmation of final position. No need for extreme head extension or forced traction of laryngoscope. Can be rapidly assembled for immediate use.
VivaSight-SL (Ambu)	Single-use ETT with an integrated camera at the tip. Image is displayed on a monitor via a cable.	ID 7.0, 7.5 8.0 mm.	Direct view during intubation; useful for verifying ETT and endobronchial blocker placement and repositioning. Indicated for use during routine or difficult intubation.	Continuous visualization allows real-time observation and monitoring of ETT or endobronchial blocker position throughout procedure.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 3. Flexible Intubation Scopes
aScope 3 Large (Ambu)	Single-use FIS. OD: 5.8 mm; working channel ID: 2.8 mm.	60 cm (ETTs =7.0 mm).	Alternative to reusable FIS with large working channel (e.g., for BAL or secretion management).	Fully disposable, sterile FIS avoids cleaning/reprocessing issues and repair costs. Attaches to high-quality aView monitor with onboard recording of video and images.
aScope 3 Regular (Ambu)	Single-use FIS. OD: 5.0 mm; working channel ID: 2.2 mm.	60 cm (ETTs =6.0 mm).	Alternative to standard reusable FIS.	Same as Ambu aScope 3 Large.
aScope 3 Slim (Ambu)	Single-use FIS. OD: 3.8 mm; working channel ID: 1.2 mm.	60 cm (ETTs =5.0 mm).	Equivalent to standard reusable pediatric FIS. Especially useful for positioning DLTs and bronchial blockers.	Same as Ambu aScope 3 Large.
aScope 4 Broncho Large (Ambu)	Single-use FIS. OD: 5.8 mm; working channel ID: 2.8 mm.	60 cm (ETTs =7.0 mm).	Alternative to reusable FIS with large working channel (e.g., for BAL or secretion management).	Same as aScope 3 Large but with improved image quality, better bending, and new ergonomic design.
aScope 4 Broncho Regular (Ambu)	Single-use FIS. OD: 5.0 mm; working channel ID: 2.2 mm.	60 cm (ETTs =6.0 mm).	Alternative to standard reusable FIS.	Same as aScope 3 Regular but with improved image quality, better bending and new ergonomic design.
aScope 4 Broncho Slim (Ambu)	Single-use FIS. OD: 3.8 mm; working channel ID: 1.2 mm.	60 cm (ETTs =5.0 mm).	Equivalent to standard reusable pediatric FIS. Especially useful for positioning DLTs and bronchial blockers.	Same as aScope 3 Slim but with improved image quality, better bending and new ergonomic design.
Broncoflex Agile (The Surgical Company Endovision)	Single-use bronchoscope. OD: 3.9 mm; working channel ID: 1.4 mm.	ETTs =5.0 mm.	Alternative to reusable bronchoscopes with large working channel, primarily used for guiding and inspection for correct positioning of DLT and bronchial blockers.	Fully disposable, sterile bronchoscope to reduce contamination, repair and cost issues associated with reusable scopes. The articulation and rigidity make for easy insertion of DLT and bronchial blockers. Comprehensive system with high-quality image and HD monitor to record video and images.
Broncoflex Vortex (The Surgical Company Endovision)	Single-use bronchoscope. OD: 5.6 mm; working channel ID: 2.8 mm.	ETTs =6.0 mm.	Alternative to reusable bronchoscopes with large working channel concealed inside a medium-sized scope and compatibility with working tools, primarily used for secretion management, BAL procedures and biopsies.	Fully disposable, sterile bronchoscope to reduce contamination, repair and cost issues associated with reusable scopes. The 2.8-mm working channel and shaped distal tip aid in exploration of the distal bronchi. Comprehensive system with high-quality image and HD monitor to record video and images.
FIVE S Scope 3.5 mm Single-Use Flexible Intubation Video Endoscope (KARL STORZ)	New single-use FIVE S is compatible with the C-MAC and C-HUB Video Intubation Platform. Similar to the reusable FIVE Scope, the distal chip provides 160,000-pixel resolution and a wide angle of view, and its rigid sheath easily maneuvers to facilitate intubation in even the most challenging situations.	3.5 mm width/65 cm length with 1.2 mm suction channel.	Oral and transnasal intubation and lung separation. Small diameter of the FIVE S 3.5 scope is ideal for DLT placement (smallest is 35 Fr DLT) use with bronchial blockers, pediatric airways, and maneuvering around challenging anatomy and obstructions to access the vocal cords when rigid devices fail. Scopes are compatible with the C-MAC monitor and C-HUB Interface, offering a complete airway management distal chip video solution.	Fully disposable, sterile FIS eliminates need for reprocessing. Ideal in emergent settings such as the ICU, ED and code carts for airway assessment and intubation. Reinforced distal tip prevents passive deflection. Minimal production variance in diameter results in ETT compatibility.
FIVE S Scope 5.3 mm Single-Use Flexible Intubation Video Endoscope (KARL STORZ)	New single-use FIVE S is compatible with the C-MAC and C-HUB Video Intubation Platform. Similar to the reusable FIVE Scope, the distal chip provides 160,000-pixel resolution and a wide angle of view, and its rigid sheath easily maneuvers to facilitate intubation in even the most challenging situations.	5.3 mm width/65 cm length with 2.2 mm suction channel.	Dual indication for intubation and bronchoscopy. Use for maneuvering around challenging anatomy and obstructions to access the vocal cords when rigid devices fail. Scopes are compatible with the C-MAC monitor and C-HUB Interface, offering a complete airway management distal chip video solution.	Fully disposable, sterile FIS eliminates need for reprocessing. Ideal in emergent settings such as the ICU, ED and code carts for airway assessment and intubation. Reinforced distal tip prevents passive deflection. Minimal production variance in diameter results in ETT compatibility.
Flexible Intubation Video Endoscope - FIVE 3.0 (KARL STORZ)	Compact, mobile endoscope. The FIVE Scope complements the C-MAC video intubation devices. Distal chip technology enhances image quality, field of view and aspect ratio to facilitate intubation. Real-time viewing on the C-MAC HD 8-inch touchscreen LCD monitor with PIP and split-screen capability.	5.5 mm with 2.3mm suction channel; 4.0 mm with 1.5 mm suction channel; 2.85 mm without suction channel.	Oral and transnasal intubation and lung separation. Small diameter of the FIVE 3.0 scope is ideal for pediatric airways, and 26 Fr DLT. The 4.0 is compatible with a 35 Fr DLT. The FIVE scopes easily maneuver around challenging anatomy and obstructions to access the vocal cords when rigid devices fail. All FIVE scopes are compatible with the C-MAC monitor and C-HUB Interface, offering a complete airway management distal chip video solution.	4:3 aspect ratio and 300,000-pixel distal chip resolution allows improved visualization of anatomy, facilitating ETT placement. Part of a system approach: 8404ZX C-MAC HD Monitor includes Dual Device Input with split-screen and PIP capabilities providing a “Plan B,” enabling use and simple exchange of several airway devices on one portable video platform (i.e., switch from VL to FIS). Improved image quality over FIS by eliminating moiré effect, providing more detailed anatomic images and permitting a full-screen image.
Flexible Intubation Video Endoscope - FIVE 4.0 (KARL STORZ)	Same as FIVE 3.0.	4.0 mm with 1.5 mm suction channel. 65 cm length. ETT >4.5 mm, DLT >35 Fr.	Oral and transnasal intubation and lung separation. Small diameter of the FIVE 4.0 scope is ideal for DLT placement (smallest is 35 Fr DLT) use with bronchial blockers, pediatric airways, and maneuvering around challenging anatomy and obstructions to access the vocal cords when rigid devices fail to do so. Scopes are compatible with the C-MAC monitor and C-HUB Interface, offering a complete airway management distal chip video solution.	Same as KARL STORZ FIVE 3.0.
Flexible Intubation Video Endoscope - FIVE 5.5 (KARL STORZ)	Same as FIVE 3.0.	5.5 mm with 2.3 mm suction channel. 65 cm length. ETT >6.0 mm.	Oral and transnasal intubation and lung separation. The FIVE 5.5 scope is ideal for adult airways, DLT placement (smallest is 41 Fr DLT) use with bronchial blockers and maneuvering around challenging anatomy and obstructions to access the vocal cords when rigid devices fail to do so. Scopes are compatible with the C-MAC monitor and C-HUB Interface, offering a complete airway management distal chip video solution.	Same as KARL STORZ FIVE 3.0.
GlideScope BFlex 2.8 (Verathon)	Same as GlideScope 3.8.	2.8 mm, no working channel. ETT >4.0 mm. 61 mm length.	Pediatric indication. Especially useful in conjunction with GlideScope Core monitors and GVL for multimodal procedures, allowing simultaneous bronchoscopy and VL views on one monitor to help during difficult airway management.	Reinforced, steady insertion tube for difficult airway cases. Handle is designed for convenience with a responsive lever making it easier to manage the scope. Measurement markers for positional accuracy and clinical reference. Convenient tube retainer to secure ETT in place during intubation. No cost or downtime associated with repair or reprocessing. Plug-and-play simplicity with GlideScope QuickConnect technology.
GlideScope BFlex 3.8 (Verathon)	Single-use flexible bronchoscope designed for difficult airways and routine bronchoscopy procedures that connects with GlideScope Core and compatible with legacy GlideScope video monitor systems.	3.8 mm with 1.2 mm working channel. ETT >5.0 mm, DLT >35 Fr. 61 cm length.	Works in conjunction with nonpowered endoscopic accessories and other ancillary equipment, for endoscopy within the airways and tracheobronchial tree. Especially useful in conjunction with GlideScope Core monitors and GVL for multimodal procedures, allowing simultaneous bronchoscopy and VL views on one monitor to help during difficult airway management.	Reinforced, steady insertion tube for difficult airway cases. Handle is designed for convenience with a responsive lever making it easier to manage the scope. Measurement markers for positional accuracy and clinical reference. Convenient tube retainer to secure ETT in place during intubation. Centralized suction and working channel ports. No cost or downtime associated with repair or reprocessing. Plug-and-play simplicity with GlideScope QuickConnect technology.
GlideScope BFlex 5.0 (Verathon)	Same as GlideScope BFlex 3.8.	5.0 mm with 2.2 mm working channel. ETT >6.0 mm. 61 cm length.	Same as GlideScope BFlex 3.8.	Same as GlideScope BFlex 3.8.
GlideScope BFlex 5.8 (Verathon)	Same as GlideScope BFlex 3.8.	5.8 mm with 3.0 mm working channel. ETT >7.0 mm. 61 cm length.	Same as GlideScope BFlex 3.8.	Same as GlideScope BFlex 3.8.
Hugemed Flexible Video Intubation Endoscope, VL3S (Bell Medical)	System comes with a video display or remote display viewing option.	2.8 mm, 3.9 mm, 5.2 mm, 5.8 mm diameter, 650 mm working length.	2.8 mm flexible scope with no channel. 3.9 mm flexible scope with 1.2 mm working channel. 5.2 mm flexible scope with 2.2 mm working channel. 5.8 mm flexible scope with 2.6 mm working channel.	Flexible angulation range 160 degrees up, 130 degrees down.
Insighter Flexible Video Endoscope (Bell Medical)	2.2-mm flexible video endoscope, non-articulating.	2.2-mm flexible scope.	Connects to HD 3.5-inch display, wireless transmitter or wired HDMI cable.	Ideal for verification of DLT position and for continuous monitoring of placement.
Insighter Flexible Articulating Video Endoscope (Bell Medical)	Has a universal HD Insight Color Display that is 3.5 inch and stores 70 hours of video and 80,000 photos. Multiple-diameter scopes to work with infants and adults. New wireless or wired communication to the 13-inch HD iWorkstation Color Display.	2.8, 4.0 and 4.5 mm with 1.2 mm channel. 5.8 mm with and without channel.	Features the 3.5-inch HD color display integrated with endoscope. Easily removed for cleaning and sterilization.	Uses LED light and LED camera at tip of endoscope eliminating the fiber-optic bundles that can easily be damaged. Articulates fully and easily to aid verifying DLT placement or in passing an ETT in a difficult intubation.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 4. Video Laryngoscopes
Airtraq Avant (Prodol Meditec)	Disposable VL that provides a magnified angular view of the glottis without alignment of oral, pharyngeal and tracheal axes. Includes a guiding channel to both hold and direct ETT toward the vocal cords. Reusable optic piece (up to 100 intubations) and anti-fog heater resists lens fogging. Disposable blade and eyecup. MRI conditional use. Also, optional camera and smartphone adapter.	Regular adult (ETTs 7.0-8.5 mm). Small adult (ETTs 6.0-7.5 mm).	Intended to facilitate intubation in both routine and difficult airway situations. Useful in all cases where ETT intubation is desired. Also appropriate for emergency settings, cervical spine immobilization, fiberscope guidance, tube exchange and foreign body removal.	Lightweight, hand-held VL. Camera enables image capture/record as well as Wi-Fi streaming to larger monitors. Optics fully isolated from patient, preventing cross-contamination. Advanced airway device with built-in anti-fog system and low-temperature light source. Can be used with standard ETTs. A built-in guide channel helps direct ETT through the vocal cords. May be used in MRI suite as MRI compatible.
Airtraq SP (Prodol Meditec)	The SP model is single use with all the features of the Avant but fully disposable. Optional camera has an integrated touch screen and can be attached to all Airtraq models. It records and can connect via Wi-Fi to smartphone/iPad/iPhone/PC.	Six color-coded sizes: regular adult (ETTs 7.0-8.5 mm); small adult (ETTs 6.0-7.5 mm); pediatric (ETTs 4.0-5.5 mm); infant (ETTs 2.5-3.5 mm); non-channeled blade; and DLTs.	Same as Airtraq Avant.	Same as Airtraq Avant but totally disposable and self-contained. 3-year shelf life.
APA (Venner Medical)	Offers continuous O₂ delivery during laryngoscopy; MAC and MIL style blades for use in pediatric, adult and difficult airway patients. APA VL’s modular design, along with its 3.5-inch monitor, allows the user to choose the airway management technique required for each patient. A disposable cover for the device is also available to protect it from contamination risks and a stylet to assist laryngoscopy.	10 disposable blade types: MIL 1, 2 (pediatric); MAC 3, 4 (adult); DAB, U-DAB (channeled and non-channeled difficult airway blades); APA Oxy Blade; MAC 3, 4, DAB, U-DAB (oxygenation blades).	Suitable for use in EMS, military, ED, ICU, pediatric units, crash cart settings and teaching hospitals to assist direct and indirect laryngoscopy in routine and difficult airways.	APA VL offers six styles of laryngoscopy on one device; traditional, MIL, pediatric, MAC, difficult airways, and its newest range of oxygenation blades for improving apnea time. Dual-battery system allows device to be used as a traditional or VL, for a customized solution with one device. APA Oxy Blade allows oxygenation directly into oropharynx at recommended flow rates of 15 L/min during laryngoscopy.
ClearVue (Infinium)	Includes a 2.0 megapixel full-view camera with high-resolution monitor. Rechargeable lithium-ion battery for extended use. Anti-fog capability is also provided.	MAC 1-5 (disposable and reusable blades); MIL 0, 1.	High-resolution view of the glottis enables first-attempt success while minimizing any chance of a complication during the intubation process.	Quick shot camera button for video recording. Optional HDMI port to connect with an external monitor.
C-MAC HD (KARL STORZ)	Instant-on, battery-powered VL with standard-shaped interchangeable MAC and MIL blades for neonates through obese adults, as well as a difficult airway blade (D-BLADE) for very adult and pediatric anterior airways. Blades house 800P HD distal chip and LED technology. The D-BLADE has angle of view with approximately 80-degree acute curvature design. Real-time viewing on the C-MAC HD 8-inch touchscreen LCD monitor with PIP and split-screen capability or portable 3.5-inch Pocket Monitor. Both modalities offer video and still picture recording conveniently located at the laryngoscope handle.	MAC 0, 2, 3, 4; MIL 0, 1, 2, MAC 3, 4 with channel for suction; adult and pediatric D-BLADE.	Useful for anterior airways, obese patients, and patients with limited mouth opening or neck extension. Variety of blade sizes and designs accommodates patients ranging from neonate (500 g) to morbidly obese. Additionally, useful for teaching purposes, verification of ETT position, aiding application of external laryngeal manipulation or passage of an intubating introducer. Also may be used for nasal intubation and ETT exchange.	Unique platform design is compatible with multiple intubation devices, including VL, the FIVE distal chip flexible video scopes and standard eyepiece scopes (fiber-optic and semirigid) via C-CAM camera head. Built-in still and video image capture on memory card, with real-time playback on monitor. Dual input capability allows for toggling between two devices, always ready for “Plan B.” Angled distal lens provides 80-degree field of view. Inherent anti-fog design.
C-MAC Pocket Monitor (KARL STORZ)	Highly portable rescue device, 3.5-inch monitor fits directly on all C-MAC premium class reusable and single-use blades and the C-MAC Video stylet. LCD 4:3 ratio high-resolution screen works in direct sunlight; rechargeable and removable lithium ion battery lasts 1 hour; ergonomic screen can be moved in several directions and folded away for transport; fully immersible. Offers video and still picture recording conveniently located at the laryngoscope handle.	Can be used with reusable and single-use blades. Reusable: MAC 0, 2, 3, 4; MAC 3, 4 with suction channel; Miller 0, 1, 2; adult and pediatric D-BLADE. Single-use: MAC 3, 4; adult D-BLADE; MIL 0, 1.	Ideal for ICU, crash carts, ED, and all prehospital environments including EMS, ambulatory services, air transport and military. Has familiar blade design and 80-degree field of view.	Lightweight, handheld and battery-operated device well suited for areas outside the OR. Waterproof. Proprietary data transfer cable allows for better patient Information control. Extension cable allows for tomahawk approach when intubating patients in difficult positions (prehospital/emergency setting). Battery-saving auto shut-off feature with warning indicators enables the user to extend the reset timer with a push of the ergonomically placed blue button.
C-MAC S (KARL STORZ)	The highly versatile, reusable S-Imager can be used with the C-MAC 7-inch LCD monitor or portable 3.5-inch Pocket Monitor. Both modalities offer video and still picture recording conveniently located at the laryngoscope handle. Anti-fog feature. Uses single-use blades. Imager is available in adult and pediatric sizes.	MAC 3, 4; adult D-BLADE; MIL 0, 1.	Same as C-MAC VL. When used with Pocket Monitor, most ideal for the ED, and all prehospital environments including EMS, ambulatory services, air transport and military where reprocessing of blades can be a challenge. Also, suitable for NICU and PICU because of MIL 0 and 1 blade offering.	Available with a USB connector cable that can be used with RDT Tempus Pro vital signs monitor.
CoPilot VL+ (Dilon Technologies)	Portable VL designed to be used in multiple settings for every intubation. Rechargeable lithium polymer battery provides more than two hours of continuous use. Durable and portable.	Adult sizes 3, 4 disposable sheath blades with anti-fog coating.	Blade angle useful for both routine and difficult airways.	Bright, full-color, high-resolution camera and display. Only VL with patented bougie port to facilitate ETT placement. A 4.3-inch display. Fog-free disposables.
GlideScope Core 10 (Verathon)	The total airway solution featuring a 10-inch HD touch-screen monitor and comprehensive workstation for streamlined workflow. Compatible with GlideScope’s extensive portfolio of VL and the new BFlex single-use flexible bronchoscope. Most comprehensive and flexible airway visualization system for VL, bronchoscopy and multimodal airway procedures.	Spectrum single-use LoPro S1, S2, S2.5, S3, S4; MIL S0, S1; DirectView MAC S3, S4; Video Baton QC Large: disposable blade sizes 3, 4; Titanium Reusable; LoPro T2, LoPro 3 and 4 angled blades, and MAC-style 3 and 4 blades; BFlex single-use flexible bronchoscope sizes 2.8 3.8, 5.0, 5.8 mm.	Delivers an all-in-one system to visualize the airway and tracheobronchial tree for routine to difficult intubation and routine bronchoscopy procedures in a wide range of patient sizes and types. Enhances airway management visualization with live PIP imaging (Dual View on GS Core 15) to help secure difficult airways via multimodal airway procedures. Ideal for the OR, ICU and ED and in teaching environments.	Dual connection ports for two video inputs; simultaneous dual view with PIP on GS Core 10 and Dual View on GS Core 15; MagnaView to enlarge the bronchoscopy view; still image and video capture; video playback and image gallery; patient notes annotation feature; SpO₂ and pulse rate reading on screen and on captured videos; 180-degree image rotation; HDMI output for external video display; coupled with a premium workstation that offers an adjustable arm, cable organizer, prep tray, storage bin and disposal bin.
GlideScope Core 15 (Verathon)	The total airway solution featuring a 15-inch HD touch-screen monitor, compatible with GlideScope’s extensive portfolio of VL and the BFlex single-use flexible bronchoscope. Most comprehensive and flexible airway visualization system for VL, bronchoscopy and multimodal airway procedures.	Same as GlideScope Core 10.	Same as GlideScope Core 10.	Same as GlideScope Core 10.
GlideScope Go (Verathon)	Handheld, high-resolution VL system. Durable, portable and intuitive, it uses the portfolio of fully disposable, single-use blades, designed to maximize first-pass success and minimize infection rates in routine and difficult intubation, in a wide range of patient sizes and types.	Spectrum single-use LoPro S1, S2, S2.5, S3, S4; Miller S0, S1; DirectView MAC S3, S4; Video Baton 2.0 Large: disposable blade sizes 3, 4.	Ideal for use in small spaces, emergent procedures, and whenever the situation demands mobility for routine and difficult airways.	Fully submersible IP67 rating; 3.5-inch landscape color display with vertical tilt adjustment supporting a wide field of view; scratch-resistant screen with anti-glare coating; integrated battery delivers a minimum of 100 minutes of continuous use on a full charge; configurable auto-shutdown and automatic recording with removable micro-USB drive.
Hugemed VL3D (Bell Medical)	A 3.5-inch display that uses disposable MAC blades.	MAC 1, 2, 3, 4, and strong curved.	High-quality airway view facilitates both routine and difficult intubation in a wide range of patient sizes and types.	HD display improves laryngeal visualization; single-use blades.
Hugemed VL3R (Bell Medical)	A 3.5-inch display that uses reusable (1,000 times) stainless steel MIL and MAC blades.	MIL 00, 0, 1 blades plus MAC 0, 1, 2, 3, 4 reusable 316 medical-grade stainless steel.	Unique ability to use a MIL blade with benefits of a VL. High-quality airway view enables intubation in a wide range of patient sizes.	HD display improves laryngeal visualization; reusable and sterilizable.
Insighter VL iS3 (Bell Medical)	VL with 300,000-pixel camera. One of six airway devices that use the universal HD Insight video 3.5-inch display. Insight video display fits flexible endoscopes, rigid lighted stylet and VL. The displays are interchangeable on all Insight devices. New wireless or wired communication to the 13-inch HD iWorkstation Color Display. Now with four acute-angled blades and MAC 3 and 4 traditional curved blades.	Six disposable blades, including sizes SS, S, M, L angulated blades and MAC 3, 4 traditional curved blades.	Ideal for routine and difficult airways. Has a HD 3.5-inch color display that rotates and tilts 270 degrees and a three-hour or longer rechargeable battery, Wi-Fi, and HDMI-capable, photo and video with storage of 70 hours or 80,000 photos and anti-fog technology. The display can be removed for easy sterilization of blade handle.	Innovative Slider Design extends and contracts camera in seconds to allow one VL system to adjust to fit infant and pediatric laryngoscope blades up to adult and large adult blades. Integrated display and handle for total portability.
Insighter VL iS6 (Bell Medical)	VL with 1 million-pixel camera with HD 3.5-inch color display.	Four disposable blade sheaths, MAC SS, S, M, L. Sizes fit infant to adult.	High-pixel camera allows full use of 13-inch HD iWorkstation display.	Wireless communication to 13-inch wireless display.
i-view (Intersurgical)	Single-use VL incorporating a MAC blade to allow direct and indirect view. Ergonomic design. Integral LCD screen provides an optimal view in a variety of light conditions.	MAC size 4 (adult).	Designed to provide direct and indirect visualization of the larynx to facilitate ETT intubation in adults. Can be used in pre-hospital, ED, code carts, OR, ICU and satellite areas of the hospital.	Up to four-hour battery life with five-year shelf life. To reduce the potential for battery depletion, i-view automatically switches off after 20 minutes. If required, the device can be switched on again by pressing the on/off button.
King Vision (Ambu)	Durable, fully portable digital VL with a high-quality reusable display and disposable blades. Handheld, on-board display avoids cables and encourages patient focus. Disposable blades incorporate camera and light source for fresh optics at each use.	Size 3 standard (13-mm minimum mouth opening) and size 3 channeled (18-mm minimum mouth opening); channeled blade allows ETTs 6.0-8.0 mm.	Hyperangulated blade design facilitates both routine and difficult intubations.	Can be used alone or with other techniques. Powered by three AAA batteries; high-fidelity 2.4-inch screen allows wide-angle viewing; anti-fog coating on distal lens; side of channel is soft for separation of ETT. Video out for connection to external display or video-capture device.
King Vision aBlade (Ambu)	Reusable video adapter attaches to existing display to allow use of lower-cost aBlades. Durable, fully portable digital VL with a high-quality reusable display and disposable aBlades. Handheld, on-board display avoids cables and encourages patient focus.	aBlade sizes 1, 2, 2 channeled, 3, 3 channeled.	Hyperangulated blade design facilitates both routine and difficult intubations.	Can be used alone or with other techniques. Powered by three AAA batteries; high-fidelity 2.4-inch screen allows wide-angle viewing; anti-fog coating on blade window; side of channel is soft for separation of ETT. Video out for connection to external display or video-capture device.
McGrath MAC (Medtronic)	Portable VL intubation platform designed for routine use. Equipped with either disposable MAC blades or hyperangulated blades for more anterior airways. Durable (drop tested to 2 m) and submersible. Screen displays minute-by-minute battery life countdown for improved reliability.	MAC blade sizes: 1, 2, 3, 4. X3 (hyperangulated).	Combines the benefits of video-assisted and direct visualization with a complete blade range to encourage routine use of VL in the OR, ICU/ED and EMS setting.	Requires no specialized training. Low-profile blades for improved agility and reduced dental interaction. Portrait-oriented display may help reduce blind spot. Highly portable, easy to clean and lightweight with no external cables.
ProVu VL (Flexicare)	Complete VL system with a sterile, single-use, all-metal blade and handle. Pairs with both a portable 3.5-inch and mounted 8-inch display. High-quality image with specialty blades for improved airway views.	MAC blade sizes: 1, 2, 3, 4. Hyperangulated blade sizes: 1, 2, 3, 3.5, 4. Display sizes: 3.5 and 8 inches. Range of accessories including tabletop and pole mount options.	An ultra low-profile blade with no sheath, provides more space for maneuverability and ETT delivery. Familiar ergonomic feel and handling.	Optimized camera positioning with bright white LED light, vertical tilt adjustment and blackout reduction technology for clear visualization. Displays are rechargeable and wipe-down capable.
VividTrac (FUJIFILM SonoSite)	Video intubation device that works on many computer systems equipped with USB II port as a standard USB camera, using available video camera applications on Windows, Mac and Linux systems. Alternatively, automated video display software (VividVision) can be downloaded.	ETTs 6.0-8.5 mm.	Intended to facilitate intubation in both routine and difficult airway situations.	VividTrac is inserted more like an oral airway device (or SGA) than a laryngoscope blade. The ETT can be preloaded or inserted once visualization is achieved in the VividTrac tube channel.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 5. Specialty Rigid Laryngoscopes
Dörges Emergency Laryngoscope Blade (KARL STORZ)	Developed in Europe as a universal blade that combines features of both the MAC and MIL laryngoscope blades.	One size only for patients >10 kg to adult.	Blade is inserted into oropharynx to appropriate depth, which correlates with patient’s size.	10- and 20-kg markings on the blade.
Modified MAC blades
AincA Flex-Tip Fiber-Optic Laryngoscope Blade (Anesthesia Associates)	Flexible tip or levering fiber-optic MAC laryngoscope blades designed with a hinged tip controlled by a lever at the proximal end. Designed to fit standard handles.	Adult sizes 3, 4; pediatric size 2.	Controlled manipulation of large or floppy epiglottis. Useful in patients with a recessed mandible and decreased mouth opening.	A lever controls the tip angle through 70 degrees during intubation to lift the epiglottis, if necessary, to improve laryngeal visualization.
AincA Macintosh Viewing Prism (Anesthesia Associates)	An optically polished viewing prism for attachment to most MAC laryngoscope blades (conventional or fiber-optic). Effectively repositions the practitioner’s viewpoint to the forward portion of the MAC curve via a 30-degree refraction without inverting the image. Clips to the vertical flange of the MAC to “look around the curve of the blade.”	Sizes 2, 3, 4 for use on MAC laryngoscope blade sizes 2, 3, 4.	Allows viewing of the vocal cords even in a patient with an anterior airway position. Also useful during nasal intubation (with impaired view) and for postoperative examination of the larynx.	Built-in clip on each prism allows attachment to any MAC-type laryngoscope blade that has a standard thickness vertical flange. Usable on both conventional and fiber-optic–type MAC blades. Reusable and sterilizable.
NOVALITE Flex-Tip Fiber Optic Blade (NOVAMED USA)	Designed with an integrated fiber-optic bundle for maximized light transmission and optimal task illumination. Using advanced xenon light technology, NOVALITE fiber-optic laryngoscopes deliver enhanced illumination for safer intubation.	MAC 2, 3, 4.	Positioning of the 5.0-mm fiber-optic bundle closer to the tip of the blade further enhances visibility and ensures ease of intubation.	Designed for interchangeability with universal Green System.
NOVALITE MRI Conditional Laryngoscope (NOVAMED USA)	Featuring NOVAMED “ULTRA BRITE” fiber-optic laryngoscope technology to afford clinicians a solution for intubation within the magnetic resonance (MR) environment—ensuring improved response time, enhanced patient safety and minimized risk for trauma.	MAC 0-5; MIL 00-4.	Powered by lithium xenon technology, NOVALITE MRI Conditional fiber-optic laryngoscopes deliver enhanced illumination for safer intubation in the MR suite.	Certified to meet FDA MRI Conditional requirements up to 3.0 tesla.
NOVALITE Single Use LED Laryngoscope (NOVAMED USA)	Single-use stainless steel blades available in a complete range of neonatal to adult sizes. Medium/Penlight/Stubby handles are preloaded with batteries, packaged separately.	Blades: MAC 0, 1, 2, 3, 4; MIL 00, 0, 1, 1.5, 2, 3, 4; Wis-Hipple 1.5. Handles: Medium, Penlight, Stubby.	Ideal for code carts and large facilities with infection-control concerns and cost-efficiency requirements.	Fixed LED light source remains cool at all times for improved patient safety. Low profile neonatal/pediatric design for MIL 00, 0, 1, 1.5 sizes.
NOVALITE Reusable Fiber Optic Laryngoscope Blades (Green System) with Removable FO Bundle (NOVAMED USA)	Reusable fiber-optic laryngoscope blades with added benefits beyond enhanced illumination. Designed with a removable fiber-optic bundle to optimize cleaning and patient safety. The classic, reusable design is affordably priced, compatible with green system handles. Available in a complete range of neonatal to adult sizes. Green System handles available in Medium, Penlight and Stubby.	Blades: MAC 0, 1, 2, 3, 3.5, 4; MIL 00, 0, 1, 1.5, 2,3, 4; Wis-Hipple 1, 1.5. Robert Shaw 0, 1.	Provides optimal illumination for enhanced clarity to facilitate safer intubations. Reusable blades with removable fiber-optic bundle facilitate sterilization, helping to prevent cross-contamination, improve reliability. Compatible with Green System fiber-optic handles.	Removable fiber-optic bundle ensures optimal cleaning to improve patient safety. Classic fiber-optic blade design as preferred by clinicians.
Vie Scope (Adroit Surgical)	Allows for a straight line-of-sight view with 360 degrees maximal illumination to pass a bougie between the vocal cords. Provides the ability to intubate the patient when awake in trauma situations both in the hospital and in the field. Single use.	Adult, one size fits all.	Trauma, routine, difficult and awake intubation can now be accomplished with one scope anywhere.	Patented LED ring illumination located at the proximal end of a self-enclosed clear tube allows light to be transmitted through the lumen of the tube as well as the sidewall to avoid obstruction of light by secretions or blood.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 6. Supraglottic Ventilatory Devices
AES Ultra (AES)	All-silicone laryngeal mask with standard cuff valve.	Adult sizes 3-6.	Standard all-silicone SGA.	All silicone. Single use.
AES Ultra Clear (AES)	Silicone cuff and PVC tube, laryngeal mask with standard cuff valve.	Adult sizes 3-6.	Combines all-silicone cuff with PVC tube for cost savings.	All-silicone cuff with PVC tube. Single use.
AES Ultra EX (AES)	All-silicone, multiple-use laryngeal mask.	Pediatric to adult sizes 1-6.	Reusable, standard SGA.	40 uses.
AES Ultra Flex EX (AES)	All-silicone, wire-reinforced, multiple-use laryngeal mask.	Pediatric to adult sizes 1-6.	Reusable, wire-reinforced SGA, designed to accommodate repositioning of the head and neck during surgery.	40 uses.
Air-Q3 (Cookgas/SunMed)	Hypercurved all-silicone intubating laryngeal airway that resists kinking and has removable airway connector. Anterior portion of mask is recessed; larger mask cavity allows intubation using standard ETTs. Air-Q3 removal after intubation is accomplished by using air-Q reusable removal stylet.	Sizes (0, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0) that can accommodate standard ETTs size 4.0-9.0 mm.	Allows easy access for FIS devices. Use as routine laryngeal mask airway. Removable connector allows intubation with standardETTs =8.5 mm.	All silicone, designed to minimize folding of cuff tip on insertion. Integrated bite block reinforces the tube while decreasing need for a separate bite block. Color-coded removable connectors tethered to the airway tube, avoiding episodes of misplaced connectors.
Air-Q3G (Cookgas/SunMed)	Combines the features of Air-Q3 laryngeal mask, with the addition of dual gastric channels. These channels provide access to the esophagus with an NGT or allows the clinician to apply suction to one of the channels, and create a circle (or sump) drain at the distal tip in the esophagus.	Sizes (0, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0) that can accommodate standard ETTs size 4.0-9.0 mm.	Enhanced version of the standard Air-Q3. Indicated as primary airway device when oral ETT is not necessary or as aid to intubation in difficult situations.	All-silicone design with the same features as the Air-Q3 above. The dual gastric channels are especially suited for suction catheters and NGTs up to size 18.0 Fr.
air-Q Disposable (Cookgas)	Hypercurved intubating laryngeal airway with removable color-coded connectors. Anterior portion of mask is recessed; larger mask cavity allows intubation using standard ETTs. Removal of air-Q after intubation is accomplished by using air-Q reusable removal stylet.	Sizes (1.0, 1.5, 2.0, 2.5, 3.5, 4.5) that can accommodate standard ETTs =8.5 mm.	More secure than a face mask and less invasive than intubation with an ETT when tracheal intubation is not necessary or during unexpected difficult airway situation.	Removable color-coded connector allows intubation with standard ETTs =8.5 mm.
Air-Q3SP (Cookgas/SunMed)	Combines features of the Air-Q3 with added advantage of a self-pressurizing mask. No inflation line or pilot balloon is needed. PPV or spontaneously breathing patients inflate the mask during the uptake of ventilation.	Sizes (0, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0) that can accommodate standard ETTs 4.0-9.0 mm.	More secure than a face mask and less invasive than intubation with an ETT when tracheal intubation is not necessary or during unexpected difficult airway situation.	Incorporates the Air-Q3 design with self-inflating mask.
Air-Q3SPG (Cookgas/SunMed)	Combines features of the Air-Q3G with dual gastric channels and with added advantage of a self-pressurizing mask. No inflation line or pilot balloon is needed. PPV or spontaneously breathing patients inflate the mask during the uptake of ventilation.	Sizes (0, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0) that can accommodate standard ETTs 4.0-9.0 mm.	Same as regular Air-Q3G but eliminates need for mask inflation.	PPV self-pressurizes mask cuff. On exhalation, mask cuff decompresses to level of PEEP. Removable connector allows intubation with standard ETTs. The dual gastric channels are especially suited for suction catheters and NGTs up to size 18.0 Fr.
Aura40 (Ambu)	Same design as the Ambu AuraOnce, but reusable.	Pediatric to adult sizes 1-6.	Routine use of SGA.	Reusable.
Aura40 Straight (Ambu)	Same design as the Ambu AuraStraight, but reusable.	Pediatric to adult sizes 1-6.	Routine use of SGA.	Reusable. Available only in US.
AuraFlex (Ambu)	Disposable wire-reinforced flexible laryngeal mask.	Pediatric to adult sizes 2-6.	Designed for use in ENT, ophthalmic, dental and torso surgeries.	Integrated pilot tube and high flexibility enables positioning away from the surgical field, without loss of seal. Single use. EasyGlide texture and extra-soft cuff ease insertion and removal. Convenient depth marks for monitoring correct position of the mask.
AuraGain (Ambu)	Second-generation laryngeal mask, featuring anatomic curve for rapid placement, gastric access for suction and decompression of the stomach via a gastric tube, and integrated direct intubation capability for management of expected or unexpected difficult airway.	Pediatric to adult sizes 1-6.	Useful for ventilation and intubation. Appropriate for management of expected or unexpected difficult airway.	Allowable ETT size is designated on each device; maximum OG tube size is also included (e.g., 16 Fr for sizes 3-6). A soft, bite absorption area is integrated into the device as is a pilot fixator. Pediatric sizes 1 and 1.5 feature an innovative connector that reduces dead space by 39%.
Aura-i (Ambu)	A laryngeal mask with built-in curve and bite blocker designed as a conduit for optical tracheal intubation.	Pediatric to adult sizes 1-6.	Combines everyday routine use of SGA with direct intubation capability in case of difficult airway situations.	Anatomically correct curve designed as Ambu AuraOnce and Ambu Aura40 but specially designed as a conduit for intubation. Compatible with standard ETTs.
AuraOnce (Ambu)	A laryngeal mask with a special built-in curve that replicates natural human anatomy. It is molded in one piece with an integrated inflation line and no epiglottic bars on the anterior surface of the cuff.	Pediatric to adult sizes 1-6.	Allows easy access for FIS devices. For use in both anesthesia and emergency medicine.	Anatomically correct curve facilitates placement. One-piece mold. EasyGlide texture for ease of insertion. Convenient depth marks for monitoring correct position of the mask. MRI safe. Extra-soft cuff. If intubation is necessary or desired, recommend intubation over Aintree AEC. Single use.
AuraStraight (Ambu)	A straight laryngeal mask featuring a single-mold design and an extra-soft, thin cuff which easily conforms to the airway.	Pediatric to adult sizes 1-6.	For use in both anesthesia and emergency medicine.	Single-use, one-piece mold. EasyGlide texture for ease of insertion. Convenient depth marks for monitoring correct position of the mask. MRI safe. Extra-soft cuff.
Flexi 2G SAD (Genesis Airway Innovations)	A second-generation, single-use, flexible laryngeal mask airway with a sliding bite block. Wide-bore, wire-reinforced silicone gastric drainage channel allows drainage of large volumes of fluid and easy insertion of a large-bore OG tube. Introducer converts SGA into anatomically curved SGA for insertion into larynx.	Sizes 3-5.	For use in situations where a flexible SGA is required for surgical access and the use of a first-generation flexible SGA is unsuitable (see NAP4 guidelines). May be used in any situation where an SGA is required.	Single-use, wide-bore, reinforced silicone gastric channel, introducer converts the flexible SGA into an anatomically curved SGA for insertion and prevents rotation and folding over of the mask in the larynx. Sliding bite block gives versatility to positioning of the airway and gastric tubes. Can be exchanged for an ETT using the Aintree AEC.
i-gel (Intersurgical)	A second-generation, single-use SGA with a non-inflating cuff, designed to mirror the perilaryngeal anatomy, with an integral bite block, buccal cavity stabilizer and gastric channel. Also incorporates wide-bore airway channel to aid insertion and eliminate the potential for rotation. Can be used as a conduit for intubation under fiber-optic guidance (sizes 3-5).	Adult sizes 3-5 and pediatric sizes 1-2.5; adult sizes accommodate ETTs 6.0-8.0 mm.	For use in routine and emergency anesthesia and resuscitation in adult patients. Can be used as a conduit for intubation under fiber-optic guidance (sizes 3-5). Gastric channel provides early warning of regurgitation, allows for passing of a GT to empty stomach contents and facilitate venting (except size 1).	Single-use, non-inflating cuff allows easy and rapid insertion, provides high seal pressures, and minimizes risk for tissue compression. Gastric channel provides early warning of regurgitation. Buccal cavity stabilizer reduces risk for rotation or displacement, and integral bite block prevents occlusion of airway channel. Wide-bore airway channel also allows for use as a conduit for intubation with flexible scope guidance (sizes 3-5).
i-gel O₂ Resus Pack (Intersurgical)	A second-generation, single-use SGA with a supplementary O₂ port designed to facilitate ventilation during CCR. A color-coded hook ring is used to secure the airway support strap and aids in size identification. Non-inflating cuff that mirrors the perilaryngeal anatomy, with an integral bite block, buccal cavity stabilizer and gastric channel. The pack contains an i-gel O₂, a sachet of lubricant and an airway support strap.	Adult sizes 3-5; adult sizes accommodate ETTs 6.0-8.0 mm.	For use in routine and emergency anesthesia and resuscitation in adult patients. Can be used as a conduit for intubation under fiber-optic guidance. i-gel O₂ also can be used to provide supplementary O₂ during postoperative care or patient transfer. Gastric channel provides early warning of regurgitation, allows for passing of GT to empty stomach contents and facilitate venting.	Single-use, non-inflating cuff allows easy and rapid insertion, provides high seal pressure and minimizes risk for tissue compression. A supplementary O₂ port allows for administration of passive oxygenation as a component of CCR. Gastric channel provides early warning of regurgitation. Buccal cavity stabilizer reduces risk for rotation or displacement and integral bite block prevents occlusion of airway channel.
KING LT-D (Ambu)	Disposable, single-lumen tube with two low-pressure cuffs. Intended for insertion into upper esophagus with ventilatory openings aligned with tracheal inlet; distal cuff seals the esophagus and the proximal cuff seals the oropharynx.	Adult sizes 3-5 and pediatric sizes 2, 2.5.	Useful for routine or emergency airway management. Two cuffs provide elevated ventilatory seal; esophageal cuff provides physical barrier in esophagus, reducing gastric insufflation and providing potential aspiration protection. Commonly used in EMS.	Both cuffs are inflated with a single pilot tube/valve; printed depth marks; color-coded 15-mm connectors for each size. Also available in a compact, vacuum-sealed kit with inflation syringe and lube.
KING LTS-D (Ambu)	Disposable double-lumen LT with separate ventilation and gastric access channels. Intended for insertion into upper esophagus with ventilatory openings aligned with the tracheal Inlet; distal cuff seals the esophagus and the proximal cuff seals the oropharynx.	Adult sizes 3-5 and pediatric sizes 0, 1, 2, 2.5.	Useful for routine or emergency airway management. Two cuffs provide elevated ventilatory seal; esophageal cuff provides physical barrier in esophagus, reducing gastric insufflation and providing potential aspiration protection. Separate gastric access channel allows venting and active removal of gastric fluids. Commonly used in EMS.	Both cuffs are inflated with a single pilot tube/valve; printed depth marks; color-coded 15-mm connectors for each size. Large gastric port (sizes 3-5 allow 18 Fr OG tube passage). Also available in a compact, vacuum-sealed kit with inflation syringe and lube.
LarySeal Pro (Flexicare)	Next-generation SGA with integrated suction, reinforced bite guard, preformed anatomic curve and ETT insertion capabilities.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	Rapid and secure management for any airway. Equipped with features for difficult airways.	Large channel for improved suction. Guide system for directed ETT insertion. Epiglottic fenestrated flap prevents blockage and elevates the epiglottis for ETT or FIS insertion.
LMA Classic (Teleflex)	General-purpose airway for routine elective inpatient and outpatient surgical procedures.	Adult sizes 3-6 and pediatric sizes 1, 1.5, 2, 2.5.	Although originally developed for airway management of routine cases with spontaneous ventilation, it is now listed in the ASA Difficult Airway Algorithm as an airway ventilatory device or a conduit for tracheal intubation. Can be used in pediatric and adult patients in whom ventilation with a face mask or intubation is difficult or impossible. Also can be used as bridge to extubation and with pressure support or PPV.	Aperture bars designed to prevent blockage of the airway by he epiglottis. Reusable up to 40 times. Silicone cuff. Not made with natural rubber latex.
LMA Fastrach (Teleflex)	Designed to facilitate blind intubation without moving head or neck, allowing for single-handed insertion. Allows continuous ventilation between intubation attempts.	Adult sizes 3-5 that can accommodate special ETTs 6.0-8.0 mm.	Designed for anatomically difficult airway and included in AHA’s and ASA’s difficult airway algorithms.	Supplied as either a sterile version for single-use only, or as a reusable version that may be used =40 times. Silicone cuff. Not made with natural rubber latex.
LMA Flexible (Teleflex)	Has a reinforced airway tube that allows it to be positioned away from the surgical field while maintaining a good seal.	Adult sizes 3-6 and pediatric sizes 2, 2.5.	Ideal for ENT, ophthalmic and dental surgery, or other procedures where the surgeon and anesthesiologist compete for airway access.	Supplied as either a sterile version for single use only, or as a reusable version that may be used =40 times. Not made with natural rubber latex.
LMA Gastro with Cuff Pilot (Teleflex)	LMA specifically designed to give clinicians control of their patients’ airways while facilitating direct endoscopic access via the integrated endoscope channel. Once placed, the LMA Gastro Airway facilitates ETCO₂ monitoring throughout the procedure to support patient safety.	Adult sizes 3-5.	Designed to provide control of a patient’s airway while enabling direct access to the esophagus and upper gastrointestinal tract in adult patients undergoing endoscopic procedures.	Endoscope channel enables an endoscope (max OD, 14 mm) to be passed through the device under vision. Cuff Pilot Technology, an integrated cuff pressure indicator that provides constant at-a-glance feedback, alerting clinicians to changes in cuff pressure. Integral bite block reduces the potential for damage to, or obstruction of, the airway tube or endoscope due to biting. Adjustable holder and strap maintain the device in a neutral position during endoscope manipulation.
LMA ProSeal (Teleflex)	Double-cuff design enables seal pressures of =30 cm H₂O, and the drain tube separates the alimentary and respiratory tracts.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	Drain tube higher seal pressures along with the flexible airway tube enable longer periods of ventilation with minimal posterior pharyngeal wall damage, therefore expanding the types of procedures in which an LMA can be used.	Second cuff allows tighter seal for PPV. Silicone cuff. Reusable up to 40 times. Not made with natural rubber latex.
LMA Protector with Cuff Pilot (Teleflex)	Second-generation SGA with silicone cuff designed to achieve an oropharyngeal seal equivalent to the LMA ProSeal Airway (>30 cm H₂O). Combines a pharyngeal chamber and dual gastric drainage channels, designed specifically to minimize gastric insufflation and facilitate gastric access.	Adult sizes 3-5.	For routine procedures or to manage high-risk patients.	Elongated, inflatable silicone cuff is designed to conform to the contours of the hypopharynx and achieve an oropharyngeal seal equivalent to the LMA ProSeal Airway (>30 cm H₂O). The esophageal seal secures the distal tip at the upper esophageal sphincter and is designed to minimize gastric insufflation and facilitate gastric access. The airway tube allows for direct flexible scope–aided intubation with ETTs up to 7.5 mm.
LMA Supreme (Teleflex)	Combines features of previous LMAs to provide increased safety and ease of use. The higher seal pressure and gastric access provide a higher degree of safety. Designed to channel fluids away from the airway in the unlikely event of active or passive regurgitation and allows for diagnostic positioning.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	For routine procedures or to manage higher-risk patients.	Allows for easy insertion, higher seal pressures, and provides gastric access to suction or decompress the stomach. First Seal Technology is designed to provide adequacy of gas exchange. Second Seal Technology is designed to reduce risk for insufflation during ventilation. Designed to provide a passive conduit for unexpected regurgitation. The angle of the LMA Supreme Airway facilitates ease of insertion in various head positions.
LMA Unique (Teleflex)	Original, single-use LMA with design based on LMA Classic. Available with or without syringe and lubricant.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	Same as LMA Classic. Included in AHA 2000 Guidelines for CPR and Emergency Medicine Cardiovascular Care.	Aperture bars designed to prevent the blockage of airflow by the epiglottis. Single use. Sterile. Not made with natural rubber latex.
LMA Unique EVO with Cuff Pilot (Teleflex)	First-generation, silicone cuffed LMA that offers ETT intubation capabilities.	Adult sizes 3-5.	Enhanced design is ideal for unforeseen airway complications where intubation becomes necessary, and the silicone cuff is designed to be gentle to the anatomy.	Also features Cuff Pilot Technology, an integrated cuff pressure indicator that provides constant at-a-glance feedback, alerting clinicians to changes in cuff pressure. Single use. Sterile. Not made with natural rubber latex. MRI safe.
LMA Unique with Cuff Pilot (Teleflex)	A versatile, single-use, first-generation laryngeal mask with a medical-grade silicone cuff and integrated cuff pressure manometer.	Adult sizes 3-6 and pediatric sizes 1, 1.5, 2, 2.5.	The LMA Unique Airway is an ideal choice for routine anesthetic procedures, for difficult airway situations, or for airway management during cardiopulmonary resuscitation.	Silicone cuff is soft and flexible and conforms to the anatomy to create an effective oropharyngeal seal. Aperture bars designed to prevent the blockage of airflow by the epiglottis. Cuff Pilot Technology, an integrated cuff pressure indicator that provides constant at-a-glance feedback, alerting clinicians to changes in cuff pressure. Single use. Sterile. Not made with natural rubber latex. MRI safe.
Portex Clear PVC, Oral/Nasal, Soft Seal Cuff Tracheal Tubes (Smiths Medical)	Similar in shape to the first-generation laryngeal mask, but differs in its one-piece design, in which the cuff is softer and there is no “step” between the tube and the cuff, an integrated inflation line, no epiglottic bars on the anterior surface of the cuff and a wider ventilation orifice.	Pediatric to adult sizes 1-5.	Allows easy access for flexible scope devices.	If intubation necessary or desired, will accommodate ETT up to 7.5 mm. Single use.
Shiley (Medtronic)	A disposable, cost-effective laryngeal mask airway with integrated cuff inflation line. Designed to form a low-pressure seal around the laryngeal inlet and maintain a secure airway.	Pediatric to adult sizes 1-6.	Suitable for spontaneous, assisted or controlled ventilation during routine and emergency anesthetic procedures.	Single-use, disposable, contoured tube soft cuff with integrated cuff inflation line.
Shiley Esophageal Endotracheal Airway, Double Lumen (Medtronic)	A disposable DLT that combines the features of a conventional ETT with those of an esophageal obturator airway. Has a large proximal latex oropharyngeal balloon and a distal esophageal low-pressure cuff with eight ventilatory holes in between.	Two adult sizes: 41 Fr, height >5 ft; 37 Fr, height 4-6 ft.	Routine use of SGA but not contraindicated in non-fasting patients. Appropriate for prehospital, intraoperative and emergency use. Especially useful for patients in whom direct visualization of vocal cords is not possible, patients with massive airway bleeding or regurgitation, limited access to airway and patients in whom neck movement is contraindicated.	Ventilation possible with either tracheal or esophageal intubation. Distal cuff seals off the esophagus to prevent aspiration of gastric contents. Allows passage of an OG tube when placed in the esophagus. Single use.
Soft-Seal (Smiths Medical)	Similar in shape to the first-generation laryngeal mask, but differs in its one-piece design, in which the cuff is softer and there is no “step” between the tube and the cuff, an integrated inflation line, no epiglottic bars on the anterior surface of the cuff and a wider ventilation orifice.	Pediatric to adult sizes 1-5.	Allows easy access for flexible scope devices.	If intubation necessary or desired, will accommodate ETT up to 7.5 mm. Single use.
Solus Curve (Intersurgical)	A single-use SGA designed for those who prefer the insertion characteristics of a curved device. Includes a classic cuff shape, integral inflation line and a high-quality valve.	Adult sizes 3-5.	For use in anesthesia and emergency medicine. Single-use SGAs are latex free and supplied sterile.	Features a curved airway tube. Classic cuff shape provides optimum anatomic conformance with a firm, smooth-surfaced back plate to aid ease of insertion. Essential information, such as device size, is prominently displayed at the top of the tube and on the pilot balloon for quick visual reference. Not made with natural rubber latex.
Solus Flexible (Intersurgical)	A range of single-use SGA with a wire-reinforced tube, permits flexion without kinking and can be moved at any time mid-procedure without concern for the cessation of gas flow. Includes a classic cuff shape, integral inflation line and a high-quality valve.	Adult sizes 3-5 and pediatric sizes 2, 2.5.	For use in anesthesia and emergency medicine. An ideal solution for airway management in procedures such as ENT, dental, oromaxillary and eye surgery where the rigidity of airway devices can obscure surgical access.	Classic cuff shape provides optimum anatomic conformance with a firm, smooth-surfaced back plate to aid ease of insertion. Essential information, such as device size, is prominently displayed at the top of the tube and on the pilot balloon for quick visual reference. Not made with natural rubber latex.
Solus MRI Safe (Intersurgical)	A range of single-use SGA fitted with specially tested nonferrous valves, guaran-teed not to interfere with the magnet in an MRI scanner. The plastic valve ensures full reliability throughout the shelf life of each device.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	For use in anesthesia and emergency medicine. Single-use SGAs are latex free and supplied sterile.	Same as Solus Flexible. MRI safe.
Solus Satin (Intersurgical)	A range of single-use SGA with a softer airway tube providing Increased flexibility. Provides a classic cuff shape, an integral inflation line and a high-quality valve to ensure continual cuff integrity.	Adult sizes 3-5.	For use in anesthesia and emergency medicine. Single-use SGAs are latex free and supplied sterile.	Same as Solus Flexible.
Solus Standard (Intersurgical)	A range of single-use SGA featuring a low-friction material, classic cuff shape, integral inflation line and a high-quality valve.	Adult sizes 3-5 and pediatric sizes 1, 1.5, 2, 2.5.	For use in anesthesia and emergency medicine. Single-use SGAs are latex free and supplied sterile.	Same as Solus Flexible.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 7. Devices for Special Airway Techniques
Awake intubation
DART Nasal (Pulmodyne)	Intranasal mucosal atomization device.	Average particle size: 50 microns. Applicator dead space: 0.16 mL. Tip diameter: 0.19 inch (4.9 mm). Applicator length: 1.60 inch (41 mm).	For atomizing solutions across the naso- and oropharyngeal mucous membranes.	Delivers medications quickly with onset of action similar to IV delivery.
DART-Reach (Pulmodyne)	Laryngotracheal mucosal atomization device. With the flexible stylet, adjust the tube for a customized approach.	Average particle size: 50 microns. Applicator dead space: REACH600/700 = 0.22 mL; REACH720 = 0.13 mL. Tip diameter: 0.19 inch (4.9 mm). Applicator length: REACH600/700 = 8.60 inch (218 mm); REACH720 = 4.60 inch (117 mm).	Application of topical anesthetics to oropharynx and upper airway region. Atomizing solutions across the nasopharyngeal, laryngeal and oropharyngeal mucous membranes.	Flexible stylet to precisely deliver medications. Two sizes of stylets for custom delivery. Nonsterile. Single use.
EZ-Spray EZ-100 (Alcove Medical)	Atomizer that delivers a 15-to-60-micron mist of medication in a cost-effective, easy to use, disposable unit.	Length: 7.125 inch; height: 4.125 inch. Nozzle: 0.313 × 0.563 inch. Bottle diameter: 1.375 inch.	Application of topical anesthetic to the nose, oropharynx and upper airway of patients.	Trigger-valve system provides controlled release of compressed gas to atomizing nozzle, creating liquid spray. Gas flow adjusted to desired setting. Use with either oil- or water-based solutions. Nonsterile. Single use.
Interchangeable oral/nasal ETT (Genesis Airway innovations)	Secure the airway with an oral ETT and subsequent controlled retrograde nasal placement of the ETT. No extubation or interruption to ventilation.	Sizes 5-8 mm ID	Invaluable for patients with maxillofacial trauma or those with a difficult airway where a nasal ETT is required.	Reinforced ETT with posterior-facing bevel and bull-nosed tip designed for first-pass intubation over a FIS/bougie. Soft silicone, tapered Introducer and flexible airway tubing designed for atraumatic nasal intubation, then modified retrograde nasal placement of the oral ETT without extubation or interruption to ventilation. The nasal ETT then may be reconfigured to an oral ETT.
LMA MADgic (Teleflex)	Mucosal atomization device that incorporates a small flexible, malleable tube with an internal stiffening stylet that connects to 3 mL syringe.	Typical particle size: 30-100 microns; system dead space: 0.25 and 0.13 mL; tip diameter: 0.18 inch (4.6 mm); applicator length: 8.5 inch (21.6 cm) and 4.5 inch (11.4 cm).	Application of topical anesthetics to oropharynx and upper airway region. Fits through vocal cords, down SGA or into nasal cavity.	Malleable applicator retains memory to adapt to individual patient’s anatomy. Delivery of a fine spray mist generated by a piston syringe. Luer connection adapts to any luer lock syringe. Nonsterile. Single use.
LMA MAD Nasal (Teleflex)	Disposable, compact atomizer for delivery of medications to the nose and throat in a fine, gentle mist.	Typical particle size: 30-100 microns; system dead space: 0.13 and 0.07 mL; tip diameter: 0.17 inch (4.3 mm); applicator length: 1.65 inch (4.2 cm).	Intranasal medication delivery offers rapid, effective method to deliver selected medications to patient without need for a painful shot and without delays in onset seen with oral medications.	Rapidly effective (atomized nasal medications absorb directly into bloodstream, avoiding first-pass metabolism; atomized nasal medications absorb directly into the brain and cerebrospinal fluid via olfactory mucosa to nose–brain pathway, achieves medication levels comparable to injections). Controlled administration (exact dosing, exact volume, titratable to effect [repeat if needed]; atomizes in any position; atomized particles are optimal size for deposition across broad area of mucosa).
LMA MADomizer Bottle Atomizer (Teleflex)	Bottle atomizer comes with a positive displacement pump for delivering a variety of medications to the nose and hypopharynx.	Typical particle size: 30-100 microns; tip diameter: 0.17 inch (4.3 mm); applicator length: 4 inch (10 cm).	Delivers topical anesthetics, vasoconstrictors, and other nasal or oral medications. Allows targeted delivery of exact drug doses to the nasal and oral mucosa.	Unique pump design and disposable applicator tip reduces the risk for patient cross-contamination that can occur with compressed air atomizers. One-way check valve ensures unidirectional flow.
Model 15-RD Glass Atomizer (DeVilbiss Healthcare)	Metal atomizer; includes glass receptacle (for liquid), pair of metal outlet tubes extending from metal atomizing nozzle and adjustable tip for directing spray to inaccessible areas of the throat. Can be used with or without the RhinoGuard tip cover.	Length: 10.5 inch.	Intended for the application of topical anesthetics to the nose, oropharynx, and upper airway of patients, at the direction/discretion of a clinician.	Includes glass receptacle for dispensing the liquid; adjustable swivel top and vented nasal guard attached to a hand bulb. Can be used with all types of oil or water solutions that are compatible with rhodium metal plating. The all-metal top can be autoclaved. Reusable.
Procedural Oxygen Mask, POM (POM Medical)	Designed for delivering high concentrations of O₂ and monitoring end-tidal CO₂ during procedural or conscious sedation cases, such as upper GI, ERCP, EUS and EGD.	Pediatric to adult size masks.	Dual oral and nasal entry ports for endoscopes, optimizes O₂ concentrations, measures capnography even at high O₂ flows, allows easy unobstructed view and access to patient.	Ideal for oral or nasal FSI while keeping patient oxygenated.
Rescue ETT (Genesis Airway innovations)	Specialized ETT that couples with an airway tube designed for intubation through an SGA over a FIS and subsequent removal of the SGA over the ETT/airway complex.	Sizes 8-5.5 mm ID.	Specifically designed for first-pass intubation through an SGA over a FIS. No interruption to ventilation. Vision of ETT position in the trachea can be maintained with the FIS until the SGA is removed.	Available with both plain PVC and wire-reinforced ETTs. ETTs have bull-nosed tips with posterior-facing bevels for first-pass intubation. HVLP cuffs suitable for long-term intubation.
Retrograde intubation
Cook Retrograde Intubation Set (Cook Medical)	Available as a complete set in 6, 11 or 14 Fr. The 14 Fr version includes AEC with Rapi-Fit adapters that allow for delivery of O₂.	6.0 Fr: 50 cm; 11 Fr: 70 cm; 14 Fr: 70 cm; extra-stiff flexible J-tipped guide wire: 110 cm.	Technique used for securing a difficult airway, either alone or with other alternative airway techniques. Especially useful in patients with limited neck mobility or those with airway trauma. 6.0 Fr places tubes up to 2.5 mm ID; 11 Fr places tubes up to 4.0 mm ID; 14 Fr places ETTs up to 5 mm ID.	Packaged as a complete kit with everything needed to perform retrograde intubation. Tapered AEC allows for oxygenation using RapiFit adapters. Single use.
Face mask ventilation and nasal oxygenation
Comfort Flo (Teleflex)	HH-HFNCT.	Premature, infant, pediatric and adult.	Use of HFNCT in appropriate patients can improve oxygenation, decreasing the patient’s work of breathing, and help combat sedation-related respiratory complications during preoxygenation, induction and post extubation.	Effective delivery of HH-HFNCT. Supports flow rates ranging from 1 to 60 L/min. Customizable airway temperature and gradient control to optimize HFNCT.
Endoscopy Mask (VBM)	Face mask with diaphragm to allow simultaneous ventilation and endoscopy.	Newborn, infant, child and adult.	FSI; airway endoscopy; gastroenterology; transesophageal echocardiography.	Available in different sizes and with different sizes of diaphragms for a perfect seal during endoscopy. Special bronchoscope airway available to protect equipment and aid endoscopy.
Ergomask (Tuoren Medical Inc)	Mask with asymmetrical dome with a contoured ridge and a colored marker for finger placement.	Color-coded adult sizes: 3 (small), 4 (medium) and 5 (large).	One- and two-handed BVM ventilation.	Ergonomic design optimizes the one-handed ventilation technique. Improved seal with chin lift, head extension.
Flow-Safe II+ Disposable BiLevel CPAP (Mercury Medical)	Disposable BiLevel CPAP system with deluxe mask with comfortable head harness, including a color-coded manometer for verifying BiLevel CPAP or CPAP pressure. Flow-Safe II+ works with standard flowmeters that can deliver >10 cm H₂O CPAP pressure or approximately 10 cm H₂O IPAP pressure at 15 L/min. The Bilevel CPAP switch allows clinicians to provide either therapy mode.	Child, small adult and large adult.	Requires only one O₂ source for delivering CPAP or BiLevel CPAP pressure. Easy EPAP dial allows adjustable EPAP pressure in the BiLevel CPAP mode. Includes a built-in manometer for verified pressure readings. No assembly of separate apparatus, and the pressure-relief valve automatically adjusts to avoid excess pressure.	The lightweight disposable feature allows for easy CPAP or BiLevel CPAP therapy setup and therapy delivery during transport. Flow-Safe II+ is ideal for situations where backup BiLevel CPAP equipment is scarce or unavailable. The contoured, double-seal deluxe mask is designed to form a very good anatomic seal. The elastic head harness is easy to place, with Velcro straps that easily adjust for patient comfort.
Flow-Safe II EZ CPAP (Mercury Medical)	System includes an integrated nebulizer that requires only one O₂ source to run both the CPAP and nebulizer devices. CPAP system includes color-coded manometer for verifying CPAP pressure and pressure-relief system. Flow-Safe II EZ works with standard flow-meters that can deliver >10 cm H₂O at 15 L/min. Higher flow pressures may be necessary when running both CPAP and the nebulizer.	Child, small adult and large adult.	The Flow-Safe II EZ CPAP device is a respiratory aid intended for use with a face mask, nebulizer, and gas-supplying device to elevate pressure in the patient’s lungs while delivering aerosolized medication.	Mask features elastic head harness, quick-disconnect clips, and straight rotating port. Built-in manometer and pressure-relief valve. CPAP and nebulization through a single O₂ source.
Optiflow THRIVE (Fisher & Paykel Healthcare)	Nasal High Flow—Heated humidified nasal high-flow oxygenation system with heated humidifier, heated inspiratory tubing, automated humidity delivery and anatomically designed high-flow nasal interface. Interface option with CO₂ sampling line connection. Single or multiple-use kits available. Interfaces packaged separately. Packaged in box of 10.	Small, medium and large.	Provides nasal high-flow O₂ for preoxygenation, oxygenation during intubation (=10 mins) and for spontaneously breathing patients during procedural sedation. Reduces risk for oxygen desaturation and need for airway interventions.	High nasal flows up to 70 L/min, 100% FiO₂. In spontaneously breathing patients, Optiflow will maintain oxygenation, clear CO₂ from the anatomic dead space, provide up to 7 cm H₂O positive airway pressure and increase tidal volume. Humidification enables the high flow to be comfortable, while maintaining normal physiologic conditions of the airway mucosa. The nasal cannula allows shared access to the airway, which is advantageous for upper endoscopic procedures, awake tracheal Intubation and where bag mask ventilation is challenging.
SuperNO2VA ETT System (Vyaire Medical)	The SuperNO2VA ETT System is comprised of a SuperNO2VA ETT Mask, a head strap, a 2-L hyperinflation bag with its connection accessories, gas sampling line, O₂ tubing and manometer tubing.	Medium Adult,Large Adult or Adult Large height range: 5 ft 10 inch to 7 ft 3 Inch. Adult Medium height range: 4 ft 7 inch to 6 ft 9 inch.	The system creates a seal when positioned over a patient’s nose to direct anesthesia gas, air and/or O₂ to the upper airway during the continuum of anesthesia care through compression of the hyperinflated reservoir bag, while allowing ETCO₂ sampling from the patient’s exhaled breath from the oral/nasal areas.	SuperNO2VA ETT uses nasal positive airway pressure to preoxygenate, relieve upper airway obstruction due to decreased level of consciousness, maintain ventilation, rescue ventilate, ease access for intraoral procedures, and be used perioperatively.
Naso-Flo (Pulmodyne)	Nasopharyngeal airway with built-in capnography line, adjustable size and O₂ port.	4.0 (ID 4.0/18 Fr); 5.0 (ID 5.0/22 Fr); 6.0 (ID 6.0/25 Fr); 7.0 (ID 7.0/29 Fr); 8.0 (ID 8.0/32 Fr); 9.0 (ID 9.0/36 Fr).	Delivers direct O₂, while humidification vents positioned toward the distal tip facilitate heat and moisture transfer. It also supplies an optimal respiratory indicator with or without the hydrophobic filter.	In-line capnography. Direct O₂ port for high flow. Connects to a BVM. Soft tip for easy insertion.
Transtracheal jet ventilation
AincA Manual Jet Ventilator (Anesthesia Associates)	Portable jet ventilation device with thumb depression mechanism that initiates controlled burst of O₂ flow. Customizable assembly includes DISS inlet connection, 5 ft of inlet tubing, flow control knob, on/off thumb control, internal filter, back pressure gauge and 2 ft of outlet hose ending in a luer-lock male fitting. Connects to any tool or port that has a luer-lock female connection (i.e., malleable stylets, various adapters, etc.).	Jet ventilation catheters of malleable copper with luer lock fittings accommodate adults, children and infants. Adapters allow direct connection to bronchoscope or ETT.	Manual jet ventilation for O₂ saturation maintenance and usable for emergency direct TTJV and for laser throat surgery (elimination of plastic ETT in laser path).	Easy factory customization available for hose lengths and O₂ source connection type (DISS vs various quick-disconnect types) as well as optional pressure regulator (with gauge) and standard or custom regulator-to-source connection hoses. Adapters, fittings and connectors available. Completely reusable and sterilizable.
AincA MRI Conditional 3.0-Tesla Jet Ventilator (Anesthesia Associates)	Similar to AincA Manual Jet Ventilator but certified MRI conditional–compatible for use in units =3.0 tesla strength.	Jet ventilation catheters of malleable copper with luer lock fittings accommodate adults, children and infants. MRI conditional 3.0 tesla.	Similar to the AincA Manual Jet Ventilator, but fully certified for use in MRI suites with coil strength to 3.0 tesla. Allows emergency O₂ saturation maintenance while determining how to solve airway issues.	Easy factory customization available for hose lengths and O₂ source connection type (DISS vs various quick-disconnect types). Adapters, fittings and connectors available. Completely reusable and sterilizable.
GO-PAP (Pulmodyne)	Emergency disposable CPAP device, with integrated nebulization.	FiO₂: approximately 30%. Three PEEP settings. BiTrac ED Mask.	Offers PEEP levels 5, 7.5, 10 cm H₂O with FiO₂ level of ~30%. Constant flow and PEEP levels maintained, due to PEEP and flow being independent from the O₂ levels in the tank. Uses the barbed valve on a generator with a flow of 10 L/min.	Disposable CPAP generator with three combinations of FiO₂ and PEEP. Integrated nebulizer closed-circuit system built directly into the elbow. Neb-Connect Accessory available, which allows nebulization and CPAP therapy off the same tank.
Manual Jet Ventilator (Instrumentation Industries)	Complete set includes an on/off valve, 6 ft of high-pressure tubing, and 4 ft of small-bore tubing.	Jet ventilation catheter size 13 G can accommodate adults and 14 G children.	Same as Manujet III. Can also be used in unobstructed difficult airway management.	Offered with and without an adjustable pressure regulator. Partially reusable outlet tube is disposable. Note: Outlet tube is single use.
Manujet III (VBM)	Complete set including 13-ft high-pressure hose assembly with O₂DISS fittings, 40-degree small-bore tube assembly (with luer lock fitting) and three jet ventilation catheters (13, 14 and 16 G).	Jet ventilation catheters can accommodate adults, children and infants.	Well-accepted method for securing ventilation in rigid and interventional bronchoscopy. Because airflow is generally unidirectional, it is important that air has a route to escape (unobstructed airway).	Packaged as complete kit with jet ventilation catheters to perform TTJV. Includes gauge and regulator.
O₂-MAX (Pulmodyne)	Emergency disposable CPAP device, with integrated nebulization.	FiO₂: approximately 30%. Three PEEP settings. BiTrac ED Mask.	Offers PEEP levels 2.5-20 cm H₂O. With FiO₂ level of ~30%. Constant flow and PEEP levels maintained, due to PEEP and flow being independent from the O₂ levels in the tank. Uses the 50 PSI port.	Disposable CPAP generator with =21 cm H₂O specific combinations of FiO₂ and PEEP. Integrated nebulizer closed-circuit system built directly into the elbow.
O₂-MAX Trio (Pulmodyne)	Emergency disposable CPAP device, with integrated nebulization.	Three FiO₂ levels. Three PEEP settings. BiTrac ED Mask.	Offers PEEP levels 2.5-20 cm H₂O. Allows dial-in FiO₂ levels of ~30%, 60% and 90%. Constant flow and PEEP levels maintained, due to PEEP and flow being independent from the O₂ levels in the tank. Uses the 50 PSI port.	Disposable CPAP generator with =21 cm H₂O specific combinations of FiO₂ and PEEP. Integrated nebulizer closed-circuit system built directly into the elbow.
Transtracheal Catheter (Acutronic Medical System)	Small jet needle for puncturing the trachea in an emergency for use with jet ventilation.	13 G, 14 G.	Applications in ICU for patients with severe lung injuries, ARDS or bronchopleural fistulas.	Provides ventilation to patient who is unable to be intubated.
Ventrain (Ventinova Medical BV)	Manually operated ventilation device for ventilation through a transtracheal catheter in cannot-intubate/cannot-oxygenate situations. Ventrain requires a high-pressure O₂ source with pressure compensated flow regulator.	Ventrain has a male luer lock connector, allowing connection to a transtracheal catheter. Length: 7.5 cm; ID: 2.0 mm.	Ventrain provides full ventilation for adults through transtracheal small-gauge lumens when large-bore ventilation is not possible (cannot-intubate/cannot-ventilate situations).	Ventilation is based on bidirectional gas flow. Ventrain not only supplies O₂ during the inspiration phase but also removes gas from the lungs, by suctioning, during the expiration phase. Therefore, Ventrain can be used in situations when the airway is obstructed, reducing the risk for barotrauma.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 8. Positioning Devices
Chin-UP (Dupaco)	Hands-free airway support device used to lift up patient’s chin and hold it in position to keep the airway open.		Aids during monitored anesthesia care and total IV anesthesia sedation procedures.	Disposable polyurethane foam cushions.
Face-Cradle (Mercury Medical)	Fully adjustable cushion set accommodates most adult head sizes.		For use in prone-position surgeries.	Fully adjustable offering the clinician greater visibility of patient’s face.
Jaw Elevation Device (JED, Hypnoz Devices)	The JED assists the provider in maintaining a patient’s airway by mechanically providing jaw thrust. Once applied, the JED holds a patient’s airway open and allows an anesthesia provider to administer sedation or anesthesia safely without having to instrument the airway.	Length: 20.3 cm, accommodates jaw width 11-21.5 cm.	The JED assists the provider to maintain an open airway and offers a “hands free” solution during light or deep sedation (MAC), FOB or any time the airway is compromised.	The reusable JED is MRI-compatible. The Mandible Cups are single use only.
Pi’s Pillow and Pi’s Obesity Pillow (American Eagle Medical)	A foam base and removable pad that support the head in full extension position (sniffing) and maintains proper alignment of the upper airway during airway management. Facilitates mask ventilation, DL/VL, and makes intubation easy and efficient in situations of a difficult airway as it creates a very stable head and neck (sniffing) position.		Extremely useful when treating morbidly obese patients’ airway since it effectively raises a patient’s head, neck and shoulders to chest level and creates an extended head position. The pillow is also very useful in helping with a patient’s breathing when administering MAC anesthesia.	Available in disposable and reusable models. The disposable pillow comes with a vacuum package and can be stored easily even within a small OR. A barrier cover is provided for the pillow. Four sizes: small, medium, large, extra-large (obesity pillow).
Rapid Airway Management Positioner, RAMP (Airpal Patient Transfer Systems)	Air-assisted medical device that can be inflated to transfer and position patients for various procedures.		Allows for the positioning of a patient for laryngoscopy, extubation and central venous access. Enhances the safe apnea period, bag valve mask ventilation and chest wall excursion.	Base of RAMP is integrated with an Airpal platform (air-assisted lateral patient transfer and positioning device). Inflates and deflates, thus can remain in place during surgery and reinflate for extubation. Reusable.
Troop Elevation Pillow, TEP (Bone Foam Inc.)	Foam positioning device that quickly achieves the HELP. Includes many accessories (head cradle, arm board pads and TEPA). An impermeable barrier cover is also offered for infection control and to protect the product.		Aids airway management for obese patients by aligning upper airway axes. This improves ease of mask ventilation and facilitates intubation via DL or VL. Allows patients to breathe more comfortably during preoxygenation as well as during regional anesthesia. Increases the desaturation safety period.	Disposable and reusable formats. TEPA may be added to the TEP base unit for super morbidly obese patients (BMI >50 kg/m²).

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 9. Cricothyrotomy Devices
Needle cricothyrotomy
Emergency Transtracheal Airway Catheter (Cook Medical)	6 Fr reinforced fluorinated ethylene propylene catheter.	5.0 and 7.5 cm. 2 mm ID.	A lifesaving procedure that is the final option for cannot-ventilate/cannot-intubate patients in all airway algorithms.	Designed to be kink-resistant, specifically for the purpose of needle cricothyrotomy.
Percutaneous cricothyrotomy
Control-Cric (Pulmodyne)	Contents include a Cric-Knife, which is a dual-sided 10 mm scalpel with integrated sliding tracheal hook, and a Cric-Key, which is a cuffed 5.5 mm cric tube, with a preloaded stylet to allow for tactile feedback of the tracheal rings.	5.5 mm cric tube.	Same as Emergency Transtracheal Airway Catheter.	Designed to perform cricothyrotomy without the need for visualization, air aspiration, or reliance on fine motor skills. Packaged to simplify the procedure.
Melker Cuffed Emergency Cricothyrotomy Catheter Set (Cook Medical)	Complete set including syringe (10 cc), 2- to 18 G introducer needles with TFE catheter (short and long), 0.038-inch diameter Amplatz extra-stiff guide wire with flexible tip, scalpel, curved dilator with radiopaque stripe and PVC airway catheter. Cuffed and uncuffed airway catheter options. Also available in a Special Operations kit, which includes all of the above in a slip peel pouch and two airway catheters.	Uncuffed: 3.5 mm ID/3.8 cm, 4.0 mm ID/- 4.2 cm, 6.0 mm ID/7.5 cm. Cuffed Seldinger: 5 mm ID/9 cm. Special Ops cuffed: 5 mm ID/9 cm. Special Ops un-cuffed: 4 mm ID/4.2 cm, 6 mm ID/7.5 cm.	Same as Emergency Transtracheal Airway Catheter, is intended to establish emergency airway access when tracheal intubation cannot be performed. Also intended for use with the Seldinger technique via cricothyroid membrane; however, has capability to be used as a surgical cricothyrotomy.	Different set options including Seldinger; cuffed or uncuffed. Special operations kit is packaged in a slip peel pouch. All Melker catheters have a 15-mm connector.
Pertrach Emergency Cricothyrotomy Kit (Pulmodyne)	Contents include two splitting needles, cuffed or uncuffed trach tube, dilator with flexible leader, twill tape, syringe, extension tube and scalpel (optional).	Adult: 6.8 cm (5.6 mm ID). Child: 3.9 cm (3 mm ID), 4 cm (3.5 mm ID), 4.1 cm (4 mm ID), and 4.4 cm (5.0 mm ID).	Use in failed orotracheal or nasotracheal intubation, and/or flexible scope bronchoscopy. Immediate airway control in patients with maxillofacial, cervical spine, head, neck and multiple trauma. Also used when tracheal intubation is impossible and/or contraindicated. Immediate relief of upper airway block.	Serves as an emergency cricothyrotomy or tracheostomy device that uses a patented splitting needle and dilator to perform rapid and simple procedures.
Quicktrach I Quicktrach II (VBM)	Complete set includes airway catheter, stopper, needle and syringes that come preassembled. Quicktrach I (without cuff). Quicktrach II (with cuff).	Adult (4 mm ID). Child (2 mm ID).	Wide-bore cannula cricothyrotomy set.	Packaged as complete set with everything needed to perform a percutaneous cricothyrotomy. Removable stopper is used to prevent a “too-deep” insertion and avoid the possibility of perforating the rear tracheal wall. Conical needle tip allows for the smallest necessary stoma and reduces the risk for bleeding. Easily transported to off-site locations.
Surgical cricothyrotomy
Control-Cric (Pulmodyne)	Contents include a Cric-Knife, which is a dual-sided, 10-mm scalpel with integrated sliding tracheal hook, and a Cric-Key, which is a cuffed 5.5-mm Cric tube, with a preloaded stylet to allow for tactile feedback from the tracheal rings.	5.5-mm cric tube.	Same as Emergency Transtracheal Airway Catheter.	Designed to perform cricothyrotomy without the need for visualization, air aspiration or reliance on fine motor skills. Packaged to simplify the procedure.
Melker Surgical Cricothyrotomy Set (Cook Medical)	Cuffed cricothyrotomy tube, scalpel, tracheal hook Trousseau dilator, and blunt, curved dilator in compact package for convenient storage.	9 cm (5 mm ID).	This set provides the tools that clinicians can use if they prefer a surgical approach to performing emergency cricothyrotomy.	Complete and convenient packaging.
Melker Universal Cuffed Emergency Cricothyrotomy Catheter Set (Cook Medical)	Same as Melker Cuffed Emergency Cricothyrotomy Catheter Set for percutaneous technique. Also includes components for surgical technique: tracheal hook, safety scalpel, Trousseau dilator and blunt curved dilator.	9 cm (5 mm ID).	Same as Melker Cuffed Emergency Cricothyrotomy Catheter Set, Seldinger or Surgical Cricothyrotomy.	50% of tray same as Melker Cuffed Emergency Cricothyrotomy Catheter Set for the percutaneous technique. The other 50% includes all items needed to perform a surgical emergency cricothyrotomy, including a Trousseau dilator and tracheal hook.
Rüsch Easycric (Teleflex)	Complete Seldinger-based cricothyrotomy percutaneous set, premounted EasyCric soft 5-mm ID PVC tube and rigid ergonomic dilator (hydrophilic coating, anatomically shaped). The set contains syringe and needle, saline, nonkinking guide wire with both flexible ends and scalpel.	Adult (cannula 5 mm ID).	EasyCric emergency cricothyrotomy set is a backup device when every other procedure for O₂ delivery is impossible.	Special hydrophilic coating and anatomic design of the entire device (premounted tube and dilator, ergonomic grip, fixed neck plate), facilitates rapid insertion and handling by the clinician.
ScalpelCric (VBM)	Scalpel cricothyrotomy set “stab-twist-bougie-tube.”	6 mm ID.	Same as Melker Cuffed Emergency Cricothyrotomy Catheter Set.	Complete cricothyrotomy set, which includes size 10 scalpel; 40 cm, 14 Fr bougie; 6 mm cuffed tube.
Surgicric (VBM)	Surgical cricothyrotomy set. Surgicric II: classic surgical technique; Surgicric III: Seldinger technique.	6 mm ID.	Two sets that provide clinicians different choices for the performance of emergency cricothyrotomy.	Small pack size ideal for emergency bags. Soft tip is atraumatic. Locking mechanism prevents accidental dislocation.

Name (manufacturer)	Description	Size	Clinical applications	Special features
Table 10. Tracheostomy Devices
Percutaneous dilatational tracheostomy
Blom Tracheostomy Tubes (Pulmodyne)	Available in four sizes. Each size offers the choice of nonfenestrated and uncuffed tubes, as well as fenestrated cuffed/uncuffed tubes along with other standard inner cannulas.	4, 6, 8, 10 mm.	Features a variety of unique inner cannulas that aid in the clearance and management of secretions to help prevent ventilator-associated events and help allow speech.	Subglottic suctioning inner cannula helps manage patient secretions that pool above the cuff intermittently or continuously through fenestrations.
Blue Rhino G2-Multi Percutaneous Tracheostomy Introducer Sets and Trays (Cook Medical)	Designed to work with ISO-standard percutaneous tracheostomy tubes, the line consists of multiple configurations offering a wide range of loading dilators to fit a wide range of tracheostomy tubes (6.5, 7, 7.5, 8, 8.5, 9 and 10 mm). Loading dilators have been tested specifically for an optimal fit with a range of the Shiley Flexible Adult Tracheostomy tubes. Available stand-alone and with Shiley Flexible and Flexible Evac tracheostomy tubes sized 7.5 and 8.5 mm.	Loading dilators: 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 10 mm. Shiley Flexible Adult Tracheostomy Tubes, with Disposable Inner Cannula: 7.5 and 8.5 mm. Shiley Flexible Evac Tracheostomy Tubes with Disposable Inner Cannula: 7.5 and 8.5 mm.	Intended for percutaneous dilatational tracheostomy for management of the airway in adults only.	Consists of these primary components: an introducer needle, J-tip wire guide, introducer dilator, guiding catheter, loading dilators and single-staged Blue Rhino G2-Multi dilator. Dilation takes place in one step, using the Seldinger technique. Available in procedure packs with tracheostomy tubes, including with the Shiley Flexible Evac Tracheostomy Tubes, which offer the ability to manage subglottic secretions through a separate built-In suction channel.
Laserjet Catheter (Acutronic Medical Systems)	Double-lumen jet catheter.	Diameter: 12 Fr; length: 40 cm, 70 cm.	For use in laser airway procedures and difficult airway procedures.	Laser-safe tube; dual lumen provides extra ability for monitoring of pressures and ETCO₂.
Percutwist Set (Teleflex)	Complete set includes luer lock syringe and needle 14 G x 52 mm, nonkinking J-guide, scalpel, one PEEK plastic screw, PVC cuffed TracheoQuick tracheostomy tube with introducer. Optional parts: diameter enlarger and the 6-mm OD dilator for the beginning of procedure.	Sizes 7, 8, 9. Optional is a longer screw for obese patients. Size 8 screw has a diameter of about 12 mm and length of about 10 cm. The OD of size 8 tracheostomy tube is 11.7 mm and - high-low cuff diameter is 32 mm.	Dilation of the stoma is based on the rotation of a different-sized plastic screw without exerting any pressure on tracheal wall. The conical portion enters the trachea completely before de-rotating the screw and inserting the tracheostomy tube assembled with its introducer.	The nitinol guide wire is kink-proof. The screw has a hydrophilic coating. Packaged as a disposable complete kit.
Portex Ultraperc Percutaneous Dilation Tracheostomy Kit (Smiths Medical)	Complete set with or without a tracheostomy tube.	70 mm (7 mm ID); 5.5 mm (8 mm ID); 81 mm (9 mm ID).	Establishes transcutaneous access to the trachea below level of cricoid cartilage. Allows for smooth insertion of the tracheostomy tube over a Seldinger wire.	Packaged as a complete kit with everything needed to perform a percutaneous dilatational tracheostomy. The dilator is single-staged and prelubricated with an ergonomic handle to facilitate insertion. Disposable.
Shiley Flexible Adult Tracheostomy Tube (Medtronic)	Each size features the choice of cuffed (with the patented TaperGuard cuff technology) or uncuffed versions.	4, 5, 6, 7, 8, 9, 10 mm.	The tracheostomy tube is a single-use device.	The tracheostomy tube features a soft, flexible shaft, beveled tip and a clear flange with airflow vents around the integrated 15-mm connector.
Shiley TracheoSoft XLT Extended-Length Tracheostomy Tubes (Medtronic)	Available in four ISO sizes (5, 6, 7, 8 mm ID). Each size offers the choice of cuffed or uncuffed stylets, and proximal or distal extensions. Disposable inner cannula; replacements sold in packages of 10.	90 mm (5 mm ID); 95 mm (6 mm ID); 100 mm (7 mm ID); 105 mm (8 mm ID).	Flexible dual-cannula tube for patients with unusual anatomy. Proximal length extension for thick necks; distal length extension for long necks, tracheal stenosis or tracheomalacia.	The only fixed-flange, extended-length tube with disposable inner cannula. Flexible inner cannula conforms to shape of the outer cannula. 16 configurations to fit a wide variety of patients. Disposable.
Venner PneuX Tracheostomy Tube (Venner Medical)	Works with an automated cuff pressure controller that regulates pressure within the tracheostomy tube cuff as a complete VAP prevention system for intensive or critical care patients.	7, 8, 9 mm ID.	Facilitates ventilation and evacuation or drainage of secretions from the subglottic space for patients requiring extended periods of tracheal intubation up to 30 days.	Single-use silicone tracheostomy tube features a unique low-volume, low-pressure cuff that forms a no-fold seal within the trachea. Intracuff pressure is constantly monitored and maintained by an automated cuff pressure controller. Tracheostomy tube incorporates multiple subglottic channels allowing secretion drainage and irrigation of the subglottic space. Available as MRI-compatible and also in ETT format.
Weinmann-Multi Tracheostomy Exchange Set (Cook Medical)	Includes a Cook AEC, five ISO-standard tracheostomy loading dilators and a Blue Rhino dilator for redilation if necessary.	Loading dilators: 7.0, 7.5, 8.0, 8.5, 9.0 mm for use with tracheostomy tubes with appropriately sized inner diameters.	Intended for adult tracheostomy tube exchange.	Helps maintain stoma access and allows redilation of stoma if resistance is met. Five ISO-standard loading dilators facilitate insertion of a large range of tracheostomy tube sizes.
Surgical tracheostomy
A surgical tracheostomy is performed by making a curvilinear skin incision along relaxed skin tension lines between sternal notch and cricoid cartilage. A midline vertical incision is then made dividing strap muscles, and division of thyroid isthmus between ligatures is performed. Next, a cricoid hook is used to elevate the cricoid. An inferior-based flap or Bjork flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall. Finally, the tracheostomy tube is inserted, the cuff is inflated, and it is secured with tape around the neck or stay sutures.

Abbreviation Key

AEC	airway exchange catheter
AHA	American Heart Association
ARDS	acute respiratory distress syndrome
ASA	American Society of Anesthesiologists
AVL	Advanced Video Laryngoscope
BAL	bronchoalveolar lavage
BMI	body mass index
BVM	bag-valve-mask
CCD	charge-coupled device
CCR	cardiocerebral resuscitation
CMOS	complementary metal oxide semiconductor
CO₂	carbon dioxide
CPAP	continuous positive airway pressure
CPR	cardiopulmonary resuscitation
CPV	Cuff Pilot Valve
DAB	difficult airway blade
DCI	direct-coupled interface
DISS	diameter index safety system
DL	direct laryngoscopy
DLT	double-lumen tube
ED	emergency department
EF	extra firm
EGD	esophagogastroduodenoscopy
EMS	emergency medical services
ENT	ear, nose and throat
EPAP	expiratory positive airway pressure
ERCP	endoscopic retrograde cholangiopancreatography
ETCO₂	end-tidal carbon dioxide
ETT	endotracheal tube
EUS	endoscopic ultrasound
EVA	expiratory ventilation assistance
FiO₂	fraction of inspired oxygen
FIS	flexible intubation scope
FIVE	Flexible Intubation Video Endoscope
Fr	French
FSI	flexible scope intubation
GI	gastrointestinal
GVL	GlideScope Video Laryngoscope
HD	high-definition
HDMI	High-Definition Multimedia Interface
HELP	Head Elevated Laryngoscopy Position
HFNCT	high-flow nasal cannula therapy
HH-HFNCT	heated humidified high-flow nasal cannula therapy
ID	internal diameter

ILMA	intubating laryngeal mask airway
IPAP	inspiratory positive airway pressure
ISO	International Organization for Standardization
IV	intravenous
LCD	liquid crystal display
LED	light-emitting diode
LMA	Laryngeal Mask Airway
LT	laryngeal tube
MAC	Macintosh
MIL	Miller
MRI	magnetic resonance imaging
NGT	nasogastric tube
NICU	neonatal intensive care unit
NTSC	National Television System Committee
OD	outer diameter
OG	orogastric
OR	operating room
O₂	oxygen
PAP	positive airway pressure
PEEK	polyetheretherketone
PEEP	positive end-expiratory pressure
PICU	pediatric intensive care unit
PIP	Picture in Picture
POM	procedural oxygen mask
PPV	positive-pressure ventilation
PSI	pounds per square inch
PVC	polyvinyl chloride
PVP	polyvinylpyrrolidone
RDT	Remote Diagnostic Technologies
RTCA	Radio Technical Commission for Aeronautics
SGA	supraglottic airway
TEE	transesophageal echocardiography
TEP	Troop Elevation Pillow
TEPA	Troop Elevation Pillow Addition
TFE	tetrafluoroethylene
TTJV	transtracheal jet ventilation
U-DAB	unchanneled difficult airway blade
USB	universal serial bus
UV	ultraviolet
VAP	ventilator-associated pneumonia
VL	video laryngoscope/laryngoscopy
VLM	video laryngeal mask

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Review Articles

Current Concepts In the Management of The Difficult Airway

Volume 19, Number 1

Editor’s note: A key of abbreviations and acronyms appears below the tables.

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