Nasopharyngeal airways (NPAs) are medical devices used to maintain an open airway in patients who have difficulty breathing due to airway obstruction. Here’s an overview of NPAs, including their uses, insertion technique, and considerations. What is a Nasopharyngeal Airway? A nasopharyngeal airway (NPA) is a soft, flexible tube designed to be inserted into a patient's nasal passage to ensure the airway remains open. It bypasses obstructions in the nasopharynx, making it easier for the patient to breathe. Uses of Nasopharyngeal Airways Airway Management in Unconscious Patients: NPAs are often used when patients are unconscious or semi-conscious but retain some level of gag reflex. Seizure Management: To prevent airway obstruction during seizures.Anesthesia and Surgery: To maintain a patent airway during and after surgical procedures. Emergency Situations: In pre-hospital and emergency settings for patients with obstructed airways due to trauma, swelling, or other causes. Indications Partially or fully obstructed airway due to soft tissue relaxation.Patients with clenched jaws or other conditions make oral airway insertion difficult. Patients with intact gag reflex where an oropharyngeal airway is contraindicated. Contraindications Suspected or known basal skull fractures. Severe nasal trauma or bleeding disorders. Patients with nasal deformities or obstructions that prevent NPA insertion. Insertion Technique Preparation: Ensure the patient is in a supine position with the head in a neutral alignment. Select the appropriate size NPA (the diameter should be similar to the patient’s smallest nostril; the length should reach from the tip of the nose to the earlobe).Lubrication: Apply a water-soluble lubricant to the NPA to reduce friction during insertion.Insertion: Gently insert the NPA into the nostril (preferably the larger nostril) with the beveled end facing the septum. Advance the airway following the natural curvature of the nasal passage. If resistance is encountered, rotate slightly or try the other nostril. Ensure the flange rests against the nostril opening once fully inserted.Verification: Check for proper placement by assessing airflow through the NPA and observing chest rise. Monitor for signs of respiratory distress or discomfort. Care and Maintenance Regularly assess the patient to ensure the NPA remains in the correct position and is functioning properly. Monitor for signs of nasal irritation, bleeding, or infection. Replace the NPA as necessary based on patient's condition and clinical guidelines. Advantages of Nasopharyngeal Airways Less likely to induce gag reflex compared to oropharyngeal airways. Can be used in patients with oral injuries or trauma. Provides a reliable airway in various clinical settings, including emergencies. Disadvantages of Nasopharyngeal Airways Risk of nasal trauma or bleeding. Potential for incorrect placement to ineffective airway management. Possible discomfort for conscious patients. Conclusion Nasopharyngeal airways are crucial tools in airway management, offering an effective means to maintain a patent airway in various clinical scenarios. Proper selection, insertion, and monitoring are essential to ensure patient safety and comfort. Understanding the indications, contraindications, and techniques for using NPAs can significantly enhance patient outcomes in respiratory care.

Airway management in anesthesia refers to managing the patient's airway so that he/she has an open airway for adequate ventilation and oxygenation during anesthesia. There are medical tools designed and used for this purpose.  How is the patient's airway affected during anesthesia? When we talk about airway management in anesthesia, the subject prompts a logically relevant question: How is the patient's airway affected during anesthesia?  The patient’s airways can be affected during anesthesia in the following ways. 1) Depression of respiratory drive Anesthetics can depress the respiratory centers in the brainstem, reducing or completely inhibiting the patient's spontaneous breathing. This suppression can to hypoventilation (inadequate ventilation) or apnea (cessation of breathing), making it necessary for the anesthesia provider to manage the patient's ventilation through medical devices such as a mechanical ventilator.  2) Loss of protective airway reflexes Anesthetic agents, especially general anesthetics, suppress the central nervous system. This suppression leads to the loss of protective reflexes such as coughing, gagging, and swallowing, which normally help keep the airway clear and prevent the aspiration of foreign materials. The absence of these reflexes increases the risk of aspiration of gastric contents or other substances into the lungs. In this case, an endotracheal tube is the commonly used medical airway management device because the primary purpose of using an endotracheal tube is to secure the airway and protect the lungs from aspiration. For expert information and specifications of endotracheal tubes, you can refer to a specialized manufacturer such as this one: www.bevermedical.com (Hangzhou Bever Medical Device Co., Ltd.) Endotracheal tube from Hangzhou Bever Medical Device 3) Relaxation of airway muscles General anesthesia often involves muscle relaxants, which relax the muscles of the body, including those in the upper airway. This relaxation can to a loss of muscle tone in the tongue, soft palate, and pharyngeal muscles, potentially causing airway collapse. In particular, the tongue may fall back against the posterior pharynx, obstructing the airway. In this case, a nasopharyngeal airway can be used to solve the problem. It is an adjunct used to keep the airway open by preventing the tongue from falling back and obstructing the airway.  To give you a vivid idea of what it is, the following is an illustrative image of it. Nasopharyngeal airways from Hangzhou Bever Medical Device How to do airway management in anesthesia Some of the common medical devices used in airway management during anesthesia are a mechanical ventilator, an endotracheal tube (ETT), and a nasopharyngeal airway mentioned above. They can all ensure adequate ventilation and airway patency. The following is a detailed explanation of how each device is used. 1) Mechanical ventilator The mechanical ventilator is connected to the patient via an endotracheal tube (ETT). The ventilator delivers controlled breaths to the patient, ensuring sufficient oxygenation and removal of carbon dioxide. The ventilator continuously monitors and adjusts the delivery of breaths based on preset parameters and patient needs. It helps in managing the patient's ventilation during surgeries under general anesthesia and can be adjusted according to the patient's condition and surgical requirements. 2) Endotracheal tube (ETT) (1) Insertion: The ETT is inserted through the patient's mouth (or occasionally through the nose) and advanced into the trachea. The procedure is often performed after administering anesthetic agents and muscle relaxants to facilitate intubation. (2) Cuff Inflation: Once in place, the cuff at the end of the ETT is inflated to create a seal against the tracheal wall. This prevents air leaks and protects against aspiration of stomach contents. Notes:  The cuff is a small inflatable balloon located at the end of the ETT. The primary function of the cuff is to create a seal between the tube and the tracheal walls. This seal prevents air from leaking around the tube. The cuff also helps prevent the aspiration of gastric contents, secretions, or other fluids into the lungs. By sealing the airway, it provides a barrier that reduces the risk of aspiration pneumonia.  (3) Connection to Ventilator: The ETT is connected to a mechanical ventilator or a manual ventilation device (e.g., bag-valve mask) to provide controlled breathing and ensure adequate ventilation during anesthesia. 3) Nasopharyngeal Airway A nasopharyngeal airway is used to maintain airway patency by preventing obstruction caused by the tongue or other soft tissues in the upper airway. (1) The nasopharyngeal airway is a soft, flexible tube inserted through the patient's nostril and advanced into the nasopharynx. (2) Size Selection: The size of the nasopharyngeal airway is chosen based on the patient's age and anatomy. It should be sized appropriately to ensure effectiveness and minimize discomfort. A nasopharyngeal airway is used in situations where full intubation is not necessary. 4) Other medical devices available in addition to the above three devices Besides the three medical devices described above, the oropharyngeal airway (OPA) is another airway management option. OPA is a simple, non-invasive device used in airway management to maintain a patent airway by preventing the tongue and soft tissues from obstructing the pharynx. It is commonly used during anesthesia and in emergencies. During anesthesia, especially when muscle relaxants are used, the muscles of the upper airway can relax, causing the tongue to fall back and obstruct the airway. The OPA helps to keep the airway open by mechanically displacing the tongue away from the posterior pharyngeal wall. NPAs are contraindicated in patients with nasal trauma, fractures, or deformities. The insertion of an NPA can exacerbate these conditions or cause further injury. In such cases, an OPA is a safer alternative. Final thoughts We hope this article addresses the question you may have about how exactly health professionals handle airway management in anesthesia. It is our pleasure if our articles contribute to the promotion of understanding of healthcare practices for patients or their concerned families and friends.

A nasopharyngeal airway (NPA) is a thin, clear, flexible tube that can be inserted through the nasal passage down into the posterior pharynx to ensure airway patency. A healthcare provider needs to know when to use a nasopharyngeal airway because appropriate use of a nasopharyngeal airway has a significant impact on patient care. An obstructed upper airway is not a condition; the obstruction may happen at the nose, nasopharynx, or base of the tongue. The nasopharyngeal airway (NPA) is specifically designed to solve this problem of the patient. The airway can be used in neonates and adults. Illustration of the correctly inserted nasopharyngeal airway (extends from the tip of the nose to the posterior pharynx) A typical nasopharyngeal airway When to use a nasopharyngeal airway Regarding medical patients: Given any of the following indications, the healthcare provider will be able to determine the need to use a nasopharyngeal airway:1) If the patient has an obstructed upper airway, causing him respiratory distress. 2) Seizure management: During a seizure, a patient may experience airway compromise. Inserting an NPA can help maintain an open airway and facilitate better oxygenation during the seizure. 3) Trismus (Lockjaw): A patient with a trismus problem will not be able to open his/her mouth due to muscle spasms or rigidity. An NPA can be used in this case if he/she cannot open the mouth. 4) Facial injury: If the patient has a severe injury to his/her face which causes loss of oral airways, an NPA can be used to provide airway patency.  5) Anesthesia and sedation: Drugs for anesthesia or sedation effects may result in airway compromise; in this case, an NPA can be used for airway patency.  6) Sometimes in an emergency incident the person suffers from an obstructed airway; an NPA can be used to maintain his/her airway patency if oropharyngeal airway is not an option. Regarding surgical patients There is a possibility that the patient undergoes airway obstruction after an operation. An NPA can be inserted if this is deemed necessary to maintain an open airway. 1) Micrognathia associated with congenital syndromes (Pierre Robin sequence, Treacher Collins, or Stickler Syndrome). 2) Patients with muscular dystrophy or other syndromes affecting the airway (Velocardiofacial syndrome, Stickler syndrome, Treacher Collins Syndrome, etc) 3) Patients who have pre-existing obstructive sleep apnoea or whose upper airway structures are expected to become swollen after operation (palate repair, pharyngoplasty, tongue surgery, etc.) 4) Patients have airway obstruction with loss of pharyngeal tone following induction of anesthesia.  An NPA is generally only required for the night after an operation. It can generally be removed the next day. Contraindications and precautions Not all patients can have an NPA inserted because they may have conditions that do not allow NPA to be used on them. If any of the following is the case, it constitutes a contraindication.A. If the patient has a basilar skull fracture, there is a chance that the insertion of the NPA may penetrate the cranial cavity.  B. NPA insertion requires the patient’s possession of certain conditions, for example, he/she does not have severe nasal trauma or deformity; otherwise the insertion may cause injuries.  C. a person who has recently undergone nasal surgery should not receive NPA insertion lest the insertion action negatively affect the surgical part and cause complications.  Advice on how the NPA insertion is to be performed See if the oropharynx is obstructed by secretions, vomitus, or foreign matter. If so clear them off.  Determine the appropriate size of the nasopharyngeal airway. The airway is supposed to extend from the tip of the nose to the tragus of the ear.  The nasopharyngeal airway needs to be sufficiently lubricated.  Insert the airway posteriorly (not cephalad) parallel to the floor of the nasal cavity, with the bevel of the tip facing toward the nasal septum (ie, with the pointed end lateral and the open end of the airway facing the septum). Use gentle yet firm pressure to pass the airway through the nasal cavity under the inferior turbinate. If resistance is encountered, try rotating it slightly. If this does not help, use the other nostril for insertion.  Equipment for nasopharyngeal airway 1) Gloves and gown 2) Devices used for placing neck and head into sniffing position 3) Nasopharyngeal airways (various sizes) 4) Lubricants 5) Suctioning apparatus and other devices to clear the pharynx 6) Nasogastric tube to relieve gastric insufflation conclusion We’ve discussed when to use a nasopharyngeal airway in the passages above. It is also important to note that the performance and quality of a nasopharyngeal airway are crucially important as these have a great impact on patient healthcare. When choosing a nasopharyngeal airway we need to be concerned with the airway’s certifications, material used, design features, size, etc. For detailed information on nasopharyngeal airways, you can refer to useful websites such as this one: www.bevermedical.com

To know nasopharyngeal airway advantages and disadvantages, we first explained what the nasopharyngeal airway is. Nasopharyngeal airway is one of the two most common types of airway management devices, the other type being oropharyngeal airway. Secondly we discussed where the nasopharyngeal airway is most suitably used. The uses of any medical device in comparison with its related other types prompt the thought of what are its advantages and disadvantages. The content arrangement of this article has been designed to provide an answer to this question that people are intrigued to ask.     Nasopharyngeal Airway and Oropharyngeal Airway   1) Nasopharyngeal Airway (NPA)   A nasopharyngeal airway (NPA) is a flexible tube inserted through the nostril into the nasopharynx to maintain an open airway.   Key Features   Material: Typically made from soft, flexible rubber or silicone.   Bevel: The tip is angled (beveled) to facilitate insertion.   Flange: The wider part at the top prevents the NPA from being inserted too far.   Lubrication: Requires lubrication (usually water-based) for smoother insertion.   2) Oropharyngeal Airway   An oropharyngeal airway (OPA) is a rigid, curved plastic device used to maintain a clear airway by preventing the tongue from falling back and obstructing the oropharynx. It is used in patients who are unconscious or deeply sedated, where the gag reflex is absent (otherwise the device will stimulate the patient and cause gagging and even vomiting). The device is inserted into the mouth, and its curved shape helps to hold the tongue in place, keeping the airway open.   Key Features   Material: Typically made of rigid plastic.   Flange: The flat end (flange) remains outside the mouth, preventing the device from being inserted too far.   Curved Design: The shape conforms to the tongue and the oropharynx, holding the tongue away from the airway.   Situations Where a Nasopharyngeal Airway Can be Used   A nasopharyngeal airway can be used in the following situations suitably.   1) Semi-conscious or Conscious Patients with an Intact Gag Reflex   Semi-conscious or conscious patients usually have an active gag reflex, which means that they cannot tolerate an oropharyngeal airway (OPA). If an oropharyngeal airway is inserted it will stimulate the posterior pharynx and cause reaction of gagging.   The gag reflex may trigger vomiting, which introduces a risk of aspiration (inhalation of stomach contents into the lungs), potentially leading to aspiration pneumonia.   Instead of maintaining an open airway, gagging and vomiting can cause further airway obstruction, as the patient’s tongue or vomit could block the airway.   2) If the tongue or soft palate collapse and block the airway in the oropharynx, the nasopharyngeal airway acts as a "stent" to keep the airway open, preventing this collapse. The NPA physically holds the airway open by ensuring soft tissue doesn't block the passage of air through the pharynx.   Nasopharyngeal Airway Advantages and Disadvantages   1) Nasopharyngeal Airway (NPA) Advantages   Ease of Insertion: Nasopharyngeal airways are relatively simple to insert and can be done with minimal equipment.   Comfort: Generally more comfortable for conscious or semi-conscious patients compared to oropharyngeal airways, as nasopharyngeal airways do not provoke a gag reflex. In a conscious or semi-conscious patient, the gag reflex is present. If you insert an oropharyngeal airway in the patient the oropharyngeal airway will stimulate the patient and cause gagging and even vomiting.   Maintains Airway Patency: A nasopharyngeal airway (NPA) is designed to bypass obstructions in the upper airway, often caused by the tongue falling back in unconscious patients. When an NPA is inserted, it passes through the area where the tongue is obstructing the airway. It helps maintain an open airway by physically displacing the tongue and other soft tissues that might be blocking the passage, allowing air to flow more freely into the trachea and lungs. A nasopharyngeal airway helps to push the tongue and other tissues away from the airway, which can relieve the obstruction.   Suitable for Facial Injuries: Can be used in patients with facial trauma where an oropharyngeal airway might not be appropriate.   Less Risk of Trauma: Less likely to cause damage to the oral cavity or teeth compared to oropharyngeal airways.   2) Nasopharyngeal Airway (NPA) Disadvantages   Size Limitations: Requires correct sizing to be effective and safe; improper sizing can cause discomfort or damage.   Potential for Trauma: Insertion can cause nasal or pharyngeal trauma, especially in patients with nasal injuries or bleeding disorders.   Not Suitable for All Patients: May not be effective or appropriate for patients with severe facial injuries or those with nasal/midface trauma.   Limited to Upper Airway Obstruction: NPAs do not address obstructions in the lower airway or lung issues.   Comments and Suggestions Appreciated   We would be gratified if this article we have written is useful for readers who look for answers to the question of what are the advantages and disadvantages of nasopharyngeal airways. We appreciate your comments and suggestions.

Airway Management Devices   Airway management devices include nasopharyngeal airways and oropharyngeal airways, put in another way, nasopharyngeal airways and oropharyngeal airways are medical devices designed for airway management. In particular, they are devices that provide airway patency (open airway). In the passages below we explain what they are.     What are a Nasopharyngeal Airway and an Oropharyngeal Airway?   1) Nasopharyngeal Airway   A nasopharyngeal airway (NPA) is a soft, flexible tube that is inserted through the nostril to provide a clear passage for air from the nose to the lower airway.   Primary materials used for nasopharyngeal airway are Silicone and PVC.   A. Silicone   Characteristics: Flexible, soft, and biocompatible.   Advantages: Silicone NPAs are more comfortable for the patient, especially for longer-term use. They are less likely to cause irritation or damage to the nasal and pharyngeal tissues.   B. PVC (Polyvinyl Chloride)   Characteristics: Rigid, durable, and cost-effective.   Advantages: PVC NPAs are generally less expensive and are used in many emergency settings. They are relatively easy to insert and manage.   Usage: Often used in disposable, single-use applications due to cost-effectiveness.   Detailed descriptions of nasopharyngeal airway are available at manufacturer websites such as that of Hangzhou Bever Medical Device Co., Ltd.   Nasopharyngeal airway from Hangzhou Bever Medical Device Co., Ltd.   2) Oropharyngeal Airway   An oropharyngeal airway (OPA) is a rigid, curved plastic device. It is used in unconscious patients without a gag reflex to maintain a patent airway by keeping the tongue from blocking the pharynx.   Common materials of this type of airways are PVC, Silicone and rubber.   Difference between Nasopharyngeal and Oropharyngeal Airway   In this section, by explaining whether to use nasopharyngeal airway or oropharyngeal airway we demonstrate the difference between nasopharyngeal and oropharyngeal airway.   Suitability of Oropharyngeal Airway   For an unconscious person, the oropharyngeal airway (OPA) is generally preferred to create a clear passage for air. This is because the oropharyngeal airway is specifically designed to prevent the tongue from falling back and obstructing the airway, which is a common issue in unconscious patients.   The oropharyngeal airway is primarily designed to lift the tongue away from the back of the throat.   The oropharyngeal airway is used in an unconscious person, because when he/she is conscious his/her gag reflex is present, in which case using an OPA could cause vomiting and further complications. However, oropharyngeal airway is only necessary when the unconscious person has airway obstruction; in particular, if the tongue or soft tissues are blocking the airway, leading to poor air movement or noisy breathing (like snoring), an OPA can help maintain a clear airway.   Suitability of Nasopharyngeal Airway   When a person is conscious or semi-conscious, his/her gag reflex is present, and therefore cannot tolerate an oropharyngeal airway. Moreover, in this case, using an OPA could cause vomiting and further complications. So in a conscious or semi-conscious person, the option is the nasopharyngeal airway.   The NPA provides an alternative route for air to pass through the nasal passage, bypassing the collapsed soft tissues in the pharynx.   In situations below the device applicable is oropharyngeal airway instead of nasopharyngeal airway.   The NPA is contraindicated in certain situations, such as when there is suspected nasal or basilar skull trauma. In such cases, an OPA is a safer and more effective option. The OPA avoids the nasal route altogether, which can be particularly important in patients with facial injuries or nasal obstructions.   Nasopharyngeal and oropharyngeal airways are devices also used in emergency management of upper airway obstruction. An elaboration is included in the next section titled Emergency Management of Upper Airway Obstruction.   Emergency Management of Upper Airway Obstruction   In the emergency management of upper airway obstruction, both nasopharyngeal airways (NPA) and oropharyngeal airways (OPA) play important roles in maintaining a patent airway. Each device has specific indications and is used depending on the cause of the airway obstruction and the patient's condition.   Indications for NPA Use   1) When the airway is obstructed by soft tissue collapse (such as the tongue falling back), but the nasal passage is clear.   2) In cases of soft tissue swelling, such as from an allergic reaction, where the nasal route can bypass the obstruction in the oropharynx.   Procedure for Insertion   1) Lubricate the NPA with a water-soluble lubricant.   2) Insert the NPA gently into the nostril, following the natural curve of the nasal passage.   3) Advance the airway until it reaches the nasopharynx, ensuring that airflow can pass through the tube into the lungs.   Choosing the Appropriate Airway Device   If the patient is unconscious without a gag reflex and the tongue is obstructing the airway, choose the OPA.   If the patient is semi-conscious or has a gag reflex, use the NPA to avoid inducing vomiting or laryngospasm.   Combining with Other Airway Management Techniques   Both the OPA and NPA can be used in conjunction with bag-valve-mask ventilation for patients who require assisted breathing.   If the airway remains obstructed despite the use of an OPA or NPA, consider more advanced airway interventions such as endotracheal intubation.

With proper airway management we can ensure that the airway is open and clear for air to enter the lunges. This is important for a person’s respiration. Airway management also allows adequate ventilation and oxygenation. Without airway management, a compromised airway (for example the tongue restricts or blocks air passageway) can quickly lead to hypoxia and life-threatening conditions.   One of the most common medical devices used in airway management is a nasopharyngeal airway (NPA). It is a soft, flexible tube inserted through the nose into the posterior pharynx to maintain an open airway. For instance, if the tongue or soft palate collapse and block the airway in the oropharynx, the nasopharyngeal airway acts as a "stent" to keep the airway open, preventing this collapse. The NPA physically holds the airway open by ensuring soft tissue doesn't block the passage of air through the pharynx.     How to Insert a Nasopharyngeal Airway   1) Determine the Size of Nasopharyngeal Airway Used   If asked how do you size a nasopharyngeal airway, you can provide the steps below as your answer.   A. Determine the Diameter   Sizing by patient’s nostril size: The external diameter of the NPA should match the diameter of the patient’s nostril. A good starting point is to compare the NPA's external diameter to the size of the patient’s little finger or nostril.   Typical sizes: NPAs are measured in millimeters (mm) of internal diameter or in French (Fr) units. Common sizes are:   I. Adults: 6-9 mm internal diameter (approximately 28-34 Fr)   II. Pediatrics: 12-24 Fr (smaller internal diameter for younger children)   B. Determine the Length   The correct length of the NPA should ensure that it reaches from the patient’s nostril to just above the epiglottis without causing trauma.   Measure the length of the NPA from the tip of the patient’s nostril to the earlobe or the angle of the jaw.   Alternatively, some clinicians measure from the tip of the nostril to the tragus of the ear.   2) Position the Patient   Conscious patient: Position the patient in a supine or semi-upright position with the head in a neutral or slightly extended position.   Unconscious patient: If no spinal injury is suspected, the head can be tilted back using the head tilt-chin lift maneuver. If there is concern for cervical spine injury, perform a jaw thrust without moving the neck.   3) Inserting the Nasopharyngeal Airway   I. Use a water-based lubricant to reduce friction and make insertion easier. Avoid oil-based lubricants as they can damage tissues and the NPA.   II. Hold the NPA: Grasp the tube near the flange with the bevel (the angled tip) facing toward the nasal septum.   III. Insert the NPA into the nostril   A. Gently insert the lubricated NPA into one of the patient’s nostrils.   B. Angle the tube toward the floor of the nose (parallel to the hard palate), avoiding pushing it upward, which could cause trauma to the nasal mucosa.   C. Advance the NPA slowly: Gently guide it through the nasal passage. If resistance is met, try to reposition slightly or switch to the other nostril.   D. Continue to insert until the flange (the wider part at the top) rests against the nostril.   4) Assess Placement   Check for proper ventilation: You should be able to feel or hear air movement through the NPA and see chest rise if the patient is breathing.   Monitor for distress: Ensure the patient is not gagging, coughing excessively, or showing signs of discomfort.   We have explained airway management and how a nasopharyngeal airway is used for airway management. Let’s go back to history of airway management so that we have some background information about airway management to become more knowledgeable.   History of Airway Management   Ancient Times   Early Intubation Attempts (1500 BCE): The earliest known attempts at airway management were likely during ancient Egyptian times, when healers performed tracheostomies. Evidence exists from ancient Egyptian and Greek texts describing techniques to open the airway surgically.   18th Century   Scientific Inquiry (1543-1628): Renaissance physicians such as Andreas Vesalius, known as the father of modern anatomy, first described performing a tracheotomy on a pig and suggested its application to human airways.   Chevalier Jackson (Late 18th Century): Known for advancing the tracheotomy technique, Chevalier Jackson published work on airway management in the 18th century, leading to more widespread use.   19th Century   Introduction of Anesthesia (1846): The development of anesthesia marked a major turning point in airway management. During surgeries, physicians realized the need to maintain open airways, as anesthesia could suppress spontaneous breathing.   Invention of Endotracheal Tube (1878): Friedrich Trendelenburg performed one of the first successful endotracheal intubations using a rubber tube to protect the lungs from blood during surgery.   Early 20th Century   Introduction of Laryngoscope (1913): Sir Robert Macintosh and Sir Ivan Magill pioneered the development of modern laryngoscopy. This device helped physicians visualize the vocal cords for accurate tube placement.   World War I Advances: The widespread use of general anesthesia during surgery accelerated developments in airway management, including improvements in equipment and techniques for securing airways.   Mid-20th Century   Standardization of Techniques and Equipment (1940s-1960s): After World War II, endotracheal intubation became more standardized. Reusable and disposable equipment, such as improved laryngoscopes, endotracheal tubes, and ventilators, became more common.   Mechanical Ventilation (1950s): The polio epidemic led to the development of mechanical ventilation systems, such as the "iron lung," which paved the way for modern ventilators. This, in turn, increased the importance of airway management.   Late 20th Century to Present   Fiberoptic Intubation (1967): The invention of the flexible fiberoptic bronchoscope allowed physicians to perform more difficult intubations, particularly in cases where the anatomy is challenging or distorted.   Video Laryngoscopy (2000s): Video laryngoscopes, which project the airway onto a screen, have become widely used, especially in difficult airway management scenarios.   Supraglottic Airway Devices (1980s-present): Devices like the laryngeal mask airway (LMA) introduced non-invasive ways to secure airways without requiring endotracheal intubation, reducing complications in certain settings.   Modern Day   Airway Management Algorithms: Today, standardized protocols and algorithms (such as the American Society of Anesthesiologists’ difficult airway algorithm) are in place to guide clinicians in managing airways in a variety of settings.   Simulation and Training: High-fidelity simulation technology has improved the training of clinicians in airway management, allowing them to practice rare and difficult scenarios in controlled environments.