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Digital intubation relies on tactile definition of intubation landmarks, primarily the epiglottis but often the posterior cartilages and interarytenoid notch (Figs. 22.62 and 22.63).

FIGURE 22.62

Digital Intubation Technique. Index and third finger inserted into the mouth with “C”-shaped stylet held in left hand. The third finger holds the epiglottis anteriorly (insert). (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 22.63

Digital Intubation—ETT Passage. Intraoral index finger guides ETT to third finger (insert), which directs the tube into the glottic opening (insert). (Photo contributor: Lawrence B. Stack, MD.)


Digital intubation technique is performed with the intubator facing the patient from the side. With the gloved nondominant hand, the intubator should insert the index and 3rd fingers into the patient’s mouth. The intubator should next “walk” the fingers down the tongue to progressively displace the tongue anteriorly as the fingers are advanced to the epiglottis. The epiglottis will have a feel similar to the earlobe. As the 3rd finger encounters the epiglottis, the finger traps and holds the epiglottis anteriorly. The ETT, with stylet configured to an open “C,” is introduced by the dominant hand into the corner of the mouth and advanced to the palmer side of the intraoral index finger. The intraoral index finger is then used to guide the ETT tip to the 3rd finger, where the ETT is slipped between the epiglottis and 3rd finger. The 3rd finger is used to keep the ETT anterior against the laryngeal surface of the epiglottis while the ETT is advanced by the dominant hand and assisted by the intraoral index finger. It is often possible to palpate the arytenoid cartilages/interarytenoid notch, in which case one need only ensure that the ETT tip remains anterior to those cartilages and is prevented from drifting posteriorly to the esophageal inlet. The posterior cartilages project cephalad, feeling like snake fangs. Correct ETT position can be confirmed by palpating the arytenoid cartilages posterior to the ETT.

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