Introduction

 

 

Over the past forty years, different techniques of tracheal intubation have been introduced, the most effective and versatile in difficult airway situations being flexible bronchoscopy-assisted techniques. The flexible fiberoptic bronchoscope (FFB) was not developed for this purpose, nor was it used for the first flexible endosopy-assisted tracheal intubation.

 

The FFB was designed and developed based on specifications provided by Ikeda and co-workers (7) from the National Cancer Center Hospital (in Tokyo, Japan). In July 1966, the first prototype of a FFB for test use was completed by the Machida Endoscope Company and one month later, a similar prototype was presented by the Olympus Optical Company; both companies were located in Tokyo, Japan. These early prototypes had no working channel incorporated in the insertion cord and no bending mechanism for the distal end. These facilities were first implemented by the Machida Endoscope Company and in 1968, Ikeda and co-workers (7) published their preliminary experience with various prototypes for use in diagnostic bronchoscopy.
 

In 1970, Ikeda (6) presented the use of improved FFBs with a working channel incorporated in the insertion cord, a two-way bending mechanism for the distal end, and a light supplied by a powerful external fiberoptic light source for diagnostic bronchoscopy in a large series of patients. It was not until 1972, that Taylor and Towey (23) and Conyers and co-workers (3) described their techniques and experiences with a FFB for nasotracheal intubation.

 

In 1967, the first flexible endoscopy-assisted tracheal intubation was communicated by Peter Murphy, at this time anesthetist at of the National Hospital for Nervous Diseases (in London, United Kingdom), published in Anaesthesia (14), indeed a classic paper (2). He was inspired by the description of a flexible fiberoptic choledochoscope for intraoperative exploration of bile ducts (19) and used the same instrument for nasotracheal intubation under direct view. This event marked the beginning of the era of using flexible fiberoptic endoscopes in the speciality of anesthesia.

 

Remark: There was a further pioneer in anesthesia with the same surname, Francis John Murphy, who designed tracheal tubes with lateral side holes at the distal end, later modified and named Murphy-type tracheal tubes (13).

 

 

Description of the Technique Performed by Peter Murphy