• When using the McGrath video laryngoscope you usually need either a specially-shaped stylette or a bougie.
• To make your own McGrath stylette, bend a maleable aluminium stylette in the same shape as the plastic McGrath blade (see picture).
• When removing the stylette, do it slowly and and advance the tube carefully under vision. The shape of the stylette has a tendency to flick the tube out from the glottis if it is done too fast.
• The same principle applies to the GlideScope.

Some laryngoscope tips, mainly for beginners. 

• Check the light by looking at it. Also check that the light doesn’t switch off when a load is placed on the blade. Worn blades/handles may malfunction in this way.
• Hold the laryngoscope by the handle, not by the corner.
• Pull up and slightly forward to where the ceiling meets the wall.
• The MAC blade is at its thinnest profile when tilted to the right.

Simple device for spraying vocal cords. All you need is a bottle of local and a small needle. Make a hole in the bottle with the needle and aim the jet at the cords.

Suction catheter size (French) = Double the ETT size (internal diameter in mm)

For example:

• 3mm ETT = 6Fr sucker
• 4mm ETT = 8Fr sucker
• 6mm ETT = 12Fr sucker

Use a small amount of PEEP and pressure support during pre-oxygenation to overcome the resistance of the breathing circuit. It should be much easier for the patient to breath.

Remove the plunger from a syringe attached to the LMA pilot balloon so it’s open to atmospheric pressure. The LMA cuff deforms as needed on insertion making it easier to place.

• 100% O2
• Laryngospasm notch pressure
• CPAP or positive pressure ventilation
• Lignocaine on the cords
• Induction dose of propofol
• Suxamethonium IV (1 to 2mg/kg) or IM (4mg/kg)

PS - Laryngeal notch pressure: Firm pressure to the notch behind the earlobe, bounded by the mastoid process, base of skull and condyle of mandible. Pressure on both sides in a cephalad and medial direction can terminate laryngospasm. The jaw should move anteriorly. Mechanism unknown.

Larson C. Anesthesiology. 1998 Nov,(5):1293-4

Nasopharyngeal airways need a Murphy eye too. Cut your own before insertion. The hole should be opposite and proximal to the manufactured lumen.

PS - Use a 15mm endotracheal connector to connect your nasopharyngeal airway to an anaesthetic machine. This can be really useful for ENT laryngoscopy as the surgeon has an airway-device-free-view! Need spontaneously breathing patient and propofol infusion. 

The whole idea of having a PLMA with an oesophageal tube (eg: ProSeal), is to protect the glottis from regurgitation. Any gastric contents refluxing up the oesaphagus SHOULD come out the oesophageal tube. Therefore the oesophageal lumen needs to be lined up with the oesopahgus. This is not always the case when inserting the PLMA blindly. So, to ensure correct placement :

• Lubricate bougie and place in GASTRIC lumen BACKWARDS (Otherwise you won’t be able to remove it)
• Perform gentle laryngoscopy. You only need to be able to see the oesophagus or the back of the oro/hypopharynx
• Insert the bougie gently into the oesophagus
• Remove the laryngoscope and railroad the PLMA into position. There is not enough room to railroad the PLMA with the laryngoscope in the mouth 
• Check adequacy of the PLMA airway as usual (chest movement and ETCO2)
• Remove the bougie and insert a gastric tube to drain the stomach
• You can also use a gastric tube protruding from the gastric lumen, rather than a bougie, but it can be tricky to railroad the LMA over without kinking it

Ref: Brimacombe J. Anesthesiology. 2004 Jan, 100(1), 25-9

Endotracheal Tube Insertion Depth 

Forget those tricky formulae for uncuffed ETT insertion depth. They are too hard to remember.

Instead, put a size 3mm ETT 3cm at the cords. A size 4 ETT goes 4cm at the cords, etc… The trick is that you need to look at the tube first and follow it down with your eyes as you insert it through the cords, as it´s often hard to see the markings once the tube is in place. If your tube does not have cm markings, measure and draw one in the right spot with a felt-tipped pen first.

Next make sure you note what the distance is at the teeth or the lip so you know if your tube has moved. If you have a cuffed tube, insert so that the cuff is just beyond the cords.