Tracheal intubation techniques in head and neck surgery

PURPOSE OF THE REVIEW: Despite the rapid emergence of new technologies, tracheal intubation still poses pertinent challenges and remains a key driver for anesthesia-related adverse outcomes in head and neck surgery. This is related to the high incidence of obstructive and space-consuming lesions, tumors, anatomical abnormalities, and oropharyngeal bleeding. Awake or asleep tracheal intubation using direct laryngoscopy, videolaryngoscopy, flexible or rigid endoscopy, videotubes and video stylets, anterior commissure scopes, or ante- and retrograde transtracheal intubation are used to tackle difficult tracheal intubation, but novel technologies and strategies are expected to widen our armamentarium in the near future.

RECENT FINDINGS: Current research and clinical and educational concepts focus on technical and nontechnical skills, new devices, smart combinations of established devices, and evidence-based approaches. Team interaction and crew resource management are paramount. Novel preventive strategies, validated risk prediction, decision-making, and classification tools were developed to increase patients' safety and to meet the needs of rapid digital transformation in airway management.

SUMMARY: Targeted, context-specific use of tracheal intubation techniques is pivotal for effective airway management in head and neck surgery. A thorough understanding of various intubation techniques and strategies and proficiency in their application is essential for optimizing airway management, reducing complications, and ensuring patient safety.