When tools for laryngoscopy are unavailable or unreliable, endotracheal tube (ETT) insertion may be facilitated by using the fingers to guide the tube through the glottic opening,¹,² or by the use of a device designed to guide the tube through the oropharynx and into the glottis. Examples of the latter include the Williams airway intubator and the Berman intubating airway.³,⁴ In digital intubation, the index and long fingers of the nondominant hand are placed in the hypopharynx, feeling for the epiglottis anteriorly. They are then used to elevate and guide the tip of the styletted ETT just under the epiglottis, into the larynx. If reaching the epiglottis (at least) or glottis (optimally) is not possible due to short fingers or a deep larynx, the technique will be much less reliable and essentially becomes a blind thrust toward the glottis. With the Williams or Berman guides, the device is inserted into the mouth of the anesthetized or unconscious patient and the tube inserted blindly through it to be guided toward the glottis.

Little systematic testing of these techniques has been performed, nor are there useful comparative trials. Digital intubation is most likely to be used when highly unfavorable conditions for direct laryngoscopy exist, such as unavailability of a laryngoscope, copious amounts of blood or fluid in the airway, or the failure of all other techniques. It is more readily applicable in children than in adults, due to the short distance between the mouth and glottis. Case reports attest to its utility in difficult pediatric airway management.⁵,⁶ The Williams airway has been used to provide blind orotracheal intubation in the operating room in more than 300 cases, with a success rate of 80%.⁴