This is another pretty obvious finding: More attempts on laryngoscopy increases the incidence of of hypoxemia, regurgitation, and esophageal intubation. It also shows graphs showing that with less than 3 laryngoscopy attempts, the patient was usually fine. 3 or more attempts, and the risk increased dramatically. Duh. But read on.

Although the laryngoscopy can introduce some oral trauma, pain stimulation and swelling, the real risk here isn’t (as the article tries to spin it) the number of laryngoscopies, but rather the time that passes while performing them.

Where it gets a little interesting, is that they report that for emergency intubation, 1 in 10 airway encounters required 3 or more intubation attempts. When you get past 2-3 attempts, you know that you’re in deep water. And this article underpins the sound thinking that should just make you stop, think – and do something different when you reach your third attempt at laryngoscopy. You’ve already spent too much time on a plan that obviously isn’t working. Don’t cling to your laryngoscope when it’s not helping you. Have a plan.

Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts, Anesthesia & Analgesia, 2004.

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