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The History of Endotracheal Intubation.

 

Parker Medical, Colorado, USA

Jeffrey D. Parker, M.D., J.D.

 

Summary:

The study of respiratory anatomy and mechanics, which led to our current airway management tools, began with the Greeks over 2,000 years ago, and was continued in Europe and America. Instruments designed for insertion into the trachea to protect and ventilate the lungs and to supply anesthetic gases have been developed only during the past 250 years.  The evolution of this technology will be traced and discussed.

 

Abstract:

There is evidence that the Indian and Egyptian civilizations developed some practical knowledge of airway anatomy and function between 1550-2000 BC. However, this knowledge was not pursued or transmitted to other cultures.  The Western worldfs knowledge of these subjects arose independently and in a very slow and sporadic fashion, beginning in 350 BC, when Alexander the Great reportedly performed a tracheotomy with his sword on a choking soldier. 250 years later, a Greek physician reportedly performed the first surgical tracheostomy.  But a scientific understanding of airway mechanics remained lacking.  Another 260 years elapsed. In 160 AD, the Greek physician, Galen discovered the simple fact that he could inflate the lungs of a dead animal with a reed placed in its larynx.  Almost 1400 years then elapsed before Vesalius (1555) made the next, small step in elucidating the mechanics of respiration by inflating animal lungs through a reed placed in their tracheas.  Almost another 300 years elapsed before surgical tracheostomies were first practiced in Europe (in France in the 1830s) in diphtheria patients. Tracheostomy tubes were developed for this purpose and became the prototypes for the eventual development and use of translaryngeal tubes. Endotracheal tubes were designed and safely used in the 1880s by Macewen and OfDwyer. Inflatable cuffs were added by Trendelenberg (1869) and Eisenmenger (1893), and improved by Green (1906), and Guedel and Waters (1928). In the 1970s, Sheridan developed inexpensive, disposable, PVC tubes and cuffs to replace the red rubber tubes and latex cuffs made by Rusch.