Occasional intubators also sadly intubate the oesophagus too often - I recently reviewed a paper describing occasional intubators in a high resource setting, with a >10% oesophageal intubation rate (many unrecognised).

I’ll gently push back VL is an intrinsically better technique It improves laryngeal view, first pass success, reduces failure, force, trauma and complications (26,000 patients in Cochrane r/v with another 20,000 waiting to be added) In Prekker’s DEVICE study this nice supplementary graph showed how VL benefited every intubator except those with lots of experience with DL but little or no VL experience (who one might characterise as “laggards” in terms of adoption) nejm.org/doi/suppl/10.1056/N… That said - clinicians should not be undertaking high risk procedures (intubation fails dangerously) without appropriate training…..which brings us back to “the educationally difficult intubation”* Yes I’m resisting talking about tools with tools 😊

Anaesthetise Paralyse Put the head and neck in the sniffing position (flextension) Get a good view (middle of the middle) Slide a suitably small tube (6.0-6.5 mm ID for adults) along the blade into the trachea And along the trachea (which is correctly aligned by flextension) It’s not too tricky