Tracheal intubation techniques in head and neck surgery

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.

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.

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.