Description of the Technique Performed by Peter Murphy

 

 

Blind nasotracheal intubation, introduced by Magill (8), was the technique of choice in difficult airway situations and when conventional rigid laryngoscopy failed. Peter Murphy (14) was the first who communicated a technique of flexible endoscopy-assisted nasotracheal intubation under direct view.

 

Murphy used a flexible fiberoptic choledochoscope, a model manufactured by the American Cystoscope Makers Incorporated (New York, United States), as described by Shore and Lippman (19); on request, the company sent him this endoscope as object of loan. The flexible insertion cord of this endoscope was 50 cm long and had an external diameter of 6 mm, and incorporated a working channel, but these early instruments had no levering mechanism for the distal end. Both the objective lens with a 40 degree-angle of view and the eyepiece could be focused separately, producing an upright image. Light was supplied by a special fiberoptic light source, and the light intensity was sufficient for taking photographs, although of poor image quality, using a camera attached to the eyepiece. 

 

The tracheal tube (TT) was first inserted and advanced until it reached the oropharynx, later named the tube-first technique. The endoscope was then passed down through the TT until the distal end came into view. The TT and the endoscope were then advanced together as an unit and maneuvered through the laryngeal aperture, sometimes by rotation of the TT, into a midtracheal position. Murphy mentioned that the length of the endoscope was such that it could also be used to guide a TT into a bronchial position for one-lung ventilation, and soon, communicated in an interview many years later (2), he also used the endoscope for positioning of Robertshaw double-lumen bronchial tubes (17), a technique not published until 1974 (16). 

 

Murphy was already confronted with the main drawbacks associated with any technique of flexible endoscopy-assisted tracheal intubation. He recommended clearing of pharyngeal secretions by suctioning to obtain an unobstructed view and smearing the objective lens lightly with soapy water to prevent fogging before insertion of the endoscope.

 

 

Early Experiences by Others and Technical Improvements