Review Article
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Airway Techniques

Year 2025, Volume: 1 Issue: 2, 56 - 63, 01.09.2025

Abstract

Airway management is a fundamental practice of vital importance in numerous clinical specialties, including anesthesiology, emergency medicine, and intensive care. In this review, commonly used techniques in clinical practice —bag-mask ventilation, endotracheal intubation methods (direct laryngoscopy, video laryngoscopy, and flexible bronchoscopic intubation), extraglottic airway devices (LMA, Combitube), and surgical airway techniques (cricothyrotomy and tracheotomy)— have been evaluated in light of the most current evidence. The advantages, limitations, clinical indications, and procedural details of each technique have been discussed in depth. The available data demonstrate that the choice of airway method varies according to the patient’s profile and the urgency of the clinical situation. Advanced technological approaches improve success rates in difficult airway scenarios, while extraglottic and surgical interventions offer life-saving solutions during emergencies. Airway management should be approached holistically, encompassing not only technical execution but also accurate assessment, appropriate equipment selection, and sound clinical decision-making. Consequently, it is critically important for healthcare professionals to be proficient in all airway techniques and to continuously update their skills in order to ensure patient safety.

References

  • 1. Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia. 2018;73(1):93-111.
  • 2. Cooper RM. Strengths and limitations of airway techniques. Anesthesiol Clin. 2015;33(2):241-55.
  • 3. Khoury A, Hugonnot S, Cossus J, et al. From mouth-to-mouth to bag-valve-mask ventilation: evolution and characteristics of actual devices--a review of the literature. Biomed Res Int. 2014;2014:762053.
  • 4. El-Orbany M, Woehlck HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870-80.
  • 5. Isono S, Eikermann M, Odaka T. Facemask ventilation during induction of anesthesia: how "gentle" is "gentle" enough? Anesthesiology. 2014;120(2):263-5.
  • 6. Wenzel V, Idris AH, Dorges V, et al. The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway. Resuscitation. 2001;49(2):123-34.
  • 7. Holzman RS. John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero. Anesth Analg. 2021;133(6):1642-50.
  • 8. Matioc AA. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Modern" Era, 1960 to Present. Anesthesiology. 2019;130(5):686-711.
  • 9. Isono S. One hand, two hands, or no hands for maximizing airway maneuvers? Anesthesiology. 2008;109(4):576-7.
  • 10. Bell D. Avoiding adverse outcomes when faced with 'difficulty with ventilation'. Anaesthesia. 2003;58(10):945-8.
  • 11. White GM. Evolution of endotracheal and endobronchial intubation. Br J Anaesth. 1960;32:235-46.
  • 12. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-9.
  • 13. Greenland KB. Airway assessment based on a three column model of direct laryngoscopy. Anaesth Intensive Care. 2010;38(1):14-9.
  • 14. Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults. Can J Anaesth. 2009;56(6):449-66.
  • 15. Zeitels SM. Universal modular glottiscope system: the evolution of a century of design and technique for direct laryngoscopy. Ann Otol Rhinol Laryngol Suppl. 1999;179:2-24.
  • 16. Ortega R, Connor C, Kim S, Djang R, Patel K. Monitoring ventilation with capnography. N Engl J Med. 2012;367(19):e27.
  • 17. Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand. 2010;54(9):1050-61.
  • 18. Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017;119(3):369-83.
  • 19. Berkow LC, Morey TE, Urdaneta F. The Technology of Video Laryngoscopy. Anesth Analg. 2018;126(5):1527-34.
  • 20. Maissan I, van Lieshout E, de Jong T, et al. The impact of video laryngoscopy on the first-pass success rate of prehospital endotracheal intubation in The Netherlands: a retrospective observational study. Eur J Trauma Emerg Surg. 2022;48(5):4205-13.
  • 21. Savino PB, Reichelderfer S, Mercer MP, Wang RC, Sporer KA. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med. 2017;24(8):1018-26.
  • 22. Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology. 1991;75(6):1087-110.
  • 23. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014;59(6):865-78; discussion 78-80.
  • 24. Cook TM, Woodall N, Frerk C, Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31.
  • 25. Brain AI, McGhee TD, McAteer EJ, Thomas A, Abu-Saad MA, Bushman JA. The laryngeal mask airway. Development and preliminary trials of a new type of airway. Anaesthesia. 1985;40(4):356-61.
  • 26. Maltby JR, Loken RG, Watson NC. The laryngeal mask airway: clinical appraisal in 250 patients. Can J Anaesth. 1990;37(5):509-13.
  • 27. Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth. 1994;41(10):930-60.
  • 28. Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth. 1995;42(11):1017-23.
  • 29. Jannu A, Shekar A, Balakrishna R, Sudarshan H, Veena GC, Bhuvaneshwari S. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask. Arch Craniofac Surg. 2017;18(4):223-9.
  • 30. Hernandez MR, Klock PA, Jr., Ovassapian A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349-68.
  • 31. Brain AI, Verghese C, Strube PJ. The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84(5):650-4.
  • 32. Hosten T, Gurkan Y, Ozdamar D, Tekin M, Toker K, Solak M. A new supraglottic airway device: LMA-supreme, comparison with LMA-Proseal. Acta Anaesthesiol Scand. 2009;53(7):852-7.
  • 33. Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology. 2001;95(5):1175-81.
  • 34. Bamgbade OA, Macnab WR, Khalaf WM. Evaluation of the i-gel airway in 300 patients. Eur J Anaesthesiol. 2008;25(10):865-6.
  • 35. Gabbott DA, Beringer R. The iGEL supraglottic airway: a potential role for resuscitation? Resuscitation. 2007;73(1):161-2.
  • 36. Maitra S, Baidya DK, Bhattacharjee S, Khanna P. Evaluation of i-gel() airway in children: a meta-analysis. Paediatr Anaesth. 2014;24(10):1072-9.
  • 37. de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel((R)) vs laryngeal mask airway in adults. Anaesthesia. 2014;69(10):1151-62.
  • 38. Frass M, Frenzer R, Rauscha F, Weber H, Pacher R, Leithner C. Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation. Crit Care Med. 1987;15(6):609-11.
  • 39. Vaida S, Gaitini L, Frass M. Supraglottic Airway Techniques: Nonlaryngeal Mask Airways. In: Hagberg CA, Artime CA, Aziz MF, editors. Hagberg and Benumof’s Airway Management. 4th ed. Philadelphia, PA: Elsevier; 2018. p. 420-46.
  • 40. Agro F, Frass M, Benumof JL, Krafft P. Current status of the Combitube: a review of the literature. J Clin Anesth. 2002;14(4):307-14.
  • 41. Heidegger T, Gerig HJ, Ulrich B, Kreienbuhl G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations. Anesth Analg. 2001;92(2):517-22.
  • 42. Manoach S, Corinaldi C, Paladino L, et al. Percutaneous transcricoid jet ventilation compared with surgical cricothyroidotomy in a sheep airway salvage model. Resuscitation. 2004;62(1):79-87.
  • 43. Gulsen S, Unal M, Dinc AH, Altinors N. Clinically correlated anatomical basis of cricothyrotomy and tracheostomy. J Korean Neurosurg Soc. 2010;47(3):174-9.
  • 44. Holst M, Hedenstierna G, Kumlien JA, Schiratzki H. Five years experience of coniotomy. Intensive Care Med. 1985;11(4):202-6.
  • 45. Chan TC, Vilke GM, Bramwell KJ, Davis DP, Hamilton RS, Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med. 1999;17(6):957-62.
  • 46. Gibbs MA, Mick NW. Surgical Airway. In: Hagberg CA, Artime CA, Aziz MF, editors. Hagberg and Benumof’s Airway Management. 4th ed. Philadelphia, PA: Elsevier; 2018. p. 525-39.
  • 47. Francois B, Clavel M, Desachy A, Puyraud S, Roustan J, Vignon P. Complications of tracheostomy performed in the ICU: subthyroid tracheostomy vs surgical cricothyroidotomy. Chest. 2003;123(1):151-8.
  • 48. De Leyn P, Bedert L, Delcroix M, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32(3):412-21.
  • 49. Durbin CG, Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-68.
  • 50. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895-915; discussion 6-9.
  • 51. Morris LL, Whitmer A, McIntosh E. Tracheostomy care and complications in the intensive care unit. Crit Care Nurse. 2013;33(5):18-30.

Year 2025, Volume: 1 Issue: 2, 56 - 63, 01.09.2025

Abstract

References

  • 1. Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia. 2018;73(1):93-111.
  • 2. Cooper RM. Strengths and limitations of airway techniques. Anesthesiol Clin. 2015;33(2):241-55.
  • 3. Khoury A, Hugonnot S, Cossus J, et al. From mouth-to-mouth to bag-valve-mask ventilation: evolution and characteristics of actual devices--a review of the literature. Biomed Res Int. 2014;2014:762053.
  • 4. El-Orbany M, Woehlck HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870-80.
  • 5. Isono S, Eikermann M, Odaka T. Facemask ventilation during induction of anesthesia: how "gentle" is "gentle" enough? Anesthesiology. 2014;120(2):263-5.
  • 6. Wenzel V, Idris AH, Dorges V, et al. The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway. Resuscitation. 2001;49(2):123-34.
  • 7. Holzman RS. John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero. Anesth Analg. 2021;133(6):1642-50.
  • 8. Matioc AA. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Modern" Era, 1960 to Present. Anesthesiology. 2019;130(5):686-711.
  • 9. Isono S. One hand, two hands, or no hands for maximizing airway maneuvers? Anesthesiology. 2008;109(4):576-7.
  • 10. Bell D. Avoiding adverse outcomes when faced with 'difficulty with ventilation'. Anaesthesia. 2003;58(10):945-8.
  • 11. White GM. Evolution of endotracheal and endobronchial intubation. Br J Anaesth. 1960;32:235-46.
  • 12. Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-9.
  • 13. Greenland KB. Airway assessment based on a three column model of direct laryngoscopy. Anaesth Intensive Care. 2010;38(1):14-9.
  • 14. Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults. Can J Anaesth. 2009;56(6):449-66.
  • 15. Zeitels SM. Universal modular glottiscope system: the evolution of a century of design and technique for direct laryngoscopy. Ann Otol Rhinol Laryngol Suppl. 1999;179:2-24.
  • 16. Ortega R, Connor C, Kim S, Djang R, Patel K. Monitoring ventilation with capnography. N Engl J Med. 2012;367(19):e27.
  • 17. Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand. 2010;54(9):1050-61.
  • 18. Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017;119(3):369-83.
  • 19. Berkow LC, Morey TE, Urdaneta F. The Technology of Video Laryngoscopy. Anesth Analg. 2018;126(5):1527-34.
  • 20. Maissan I, van Lieshout E, de Jong T, et al. The impact of video laryngoscopy on the first-pass success rate of prehospital endotracheal intubation in The Netherlands: a retrospective observational study. Eur J Trauma Emerg Surg. 2022;48(5):4205-13.
  • 21. Savino PB, Reichelderfer S, Mercer MP, Wang RC, Sporer KA. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med. 2017;24(8):1018-26.
  • 22. Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology. 1991;75(6):1087-110.
  • 23. Collins SR, Blank RS. Fiberoptic intubation: an overview and update. Respir Care. 2014;59(6):865-78; discussion 78-80.
  • 24. Cook TM, Woodall N, Frerk C, Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31.
  • 25. Brain AI, McGhee TD, McAteer EJ, Thomas A, Abu-Saad MA, Bushman JA. The laryngeal mask airway. Development and preliminary trials of a new type of airway. Anaesthesia. 1985;40(4):356-61.
  • 26. Maltby JR, Loken RG, Watson NC. The laryngeal mask airway: clinical appraisal in 250 patients. Can J Anaesth. 1990;37(5):509-13.
  • 27. Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth. 1994;41(10):930-60.
  • 28. Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth. 1995;42(11):1017-23.
  • 29. Jannu A, Shekar A, Balakrishna R, Sudarshan H, Veena GC, Bhuvaneshwari S. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask. Arch Craniofac Surg. 2017;18(4):223-9.
  • 30. Hernandez MR, Klock PA, Jr., Ovassapian A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349-68.
  • 31. Brain AI, Verghese C, Strube PJ. The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84(5):650-4.
  • 32. Hosten T, Gurkan Y, Ozdamar D, Tekin M, Toker K, Solak M. A new supraglottic airway device: LMA-supreme, comparison with LMA-Proseal. Acta Anaesthesiol Scand. 2009;53(7):852-7.
  • 33. Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology. 2001;95(5):1175-81.
  • 34. Bamgbade OA, Macnab WR, Khalaf WM. Evaluation of the i-gel airway in 300 patients. Eur J Anaesthesiol. 2008;25(10):865-6.
  • 35. Gabbott DA, Beringer R. The iGEL supraglottic airway: a potential role for resuscitation? Resuscitation. 2007;73(1):161-2.
  • 36. Maitra S, Baidya DK, Bhattacharjee S, Khanna P. Evaluation of i-gel() airway in children: a meta-analysis. Paediatr Anaesth. 2014;24(10):1072-9.
  • 37. de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel((R)) vs laryngeal mask airway in adults. Anaesthesia. 2014;69(10):1151-62.
  • 38. Frass M, Frenzer R, Rauscha F, Weber H, Pacher R, Leithner C. Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation. Crit Care Med. 1987;15(6):609-11.
  • 39. Vaida S, Gaitini L, Frass M. Supraglottic Airway Techniques: Nonlaryngeal Mask Airways. In: Hagberg CA, Artime CA, Aziz MF, editors. Hagberg and Benumof’s Airway Management. 4th ed. Philadelphia, PA: Elsevier; 2018. p. 420-46.
  • 40. Agro F, Frass M, Benumof JL, Krafft P. Current status of the Combitube: a review of the literature. J Clin Anesth. 2002;14(4):307-14.
  • 41. Heidegger T, Gerig HJ, Ulrich B, Kreienbuhl G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations. Anesth Analg. 2001;92(2):517-22.
  • 42. Manoach S, Corinaldi C, Paladino L, et al. Percutaneous transcricoid jet ventilation compared with surgical cricothyroidotomy in a sheep airway salvage model. Resuscitation. 2004;62(1):79-87.
  • 43. Gulsen S, Unal M, Dinc AH, Altinors N. Clinically correlated anatomical basis of cricothyrotomy and tracheostomy. J Korean Neurosurg Soc. 2010;47(3):174-9.
  • 44. Holst M, Hedenstierna G, Kumlien JA, Schiratzki H. Five years experience of coniotomy. Intensive Care Med. 1985;11(4):202-6.
  • 45. Chan TC, Vilke GM, Bramwell KJ, Davis DP, Hamilton RS, Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med. 1999;17(6):957-62.
  • 46. Gibbs MA, Mick NW. Surgical Airway. In: Hagberg CA, Artime CA, Aziz MF, editors. Hagberg and Benumof’s Airway Management. 4th ed. Philadelphia, PA: Elsevier; 2018. p. 525-39.
  • 47. Francois B, Clavel M, Desachy A, Puyraud S, Roustan J, Vignon P. Complications of tracheostomy performed in the ICU: subthyroid tracheostomy vs surgical cricothyroidotomy. Chest. 2003;123(1):151-8.
  • 48. De Leyn P, Bedert L, Delcroix M, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32(3):412-21.
  • 49. Durbin CG, Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-68.
  • 50. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895-915; discussion 6-9.
  • 51. Morris LL, Whitmer A, McIntosh E. Tracheostomy care and complications in the intensive care unit. Crit Care Nurse. 2013;33(5):18-30.
There are 51 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, Anaesthesiology, Chest Diseases, Intensive Care
Journal Section Invited Review
Authors

Erbil Türksal 0000-0003-4277-3557

Publication Date September 1, 2025
Submission Date June 1, 2025
Acceptance Date June 30, 2025
Published in Issue Year 2025 Volume: 1 Issue: 2

Cite

Vancouver Türksal E. Airway Techniques. Sanatorium Med J. 2025;1(2):56-63.

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