The evolution of airway management

Overview

This article describes the most important steps of the evolution of the contemporary methods of airway management in anaesthesiology and critical care. In the 19^th century the principal method of safeguarding the open airway was tracheostomy, cannulation of the trachea and supralaryngeal tamponade prior to the beginning of general anaesthesia and surgery. Trendelenburg (1869) was the first one to use an inflatable cuff for sealing the tracheostomy cannula. MacEwen introduced inserting the tracheal tube into the larynx through the mouth in 1878. The method was improved by Maydl in Prague (1893). Magill and Rowbotham developed a well usable method of endotracheal intubation and nasotracheal blind intubation in the 1920s. Guedel developed convenient types of nasal and oral airways in the same years. He and Waters reintroduced the cuffed rubber endotracheal tube. Macintosh contributed to the technique of endotracheal intubation by introducing the curved laryngoscope blade in 1943. Thanks to the introduction of the intravenous anaesthetic thiopentone by Lundy and Waters in 1934, and muscle relaxants by Griffith in 1942, it was possible in the 1950s to develop a method for the induction of general anaesthesia with endotracheal intubation still used today.

Key words:
laryngoscopy – tracheal intubation – thiopentone – muscle relaxants