Robotic Assisted Intubation/Airway Management & Nursing Perspectives

Abstract

The landscape of emergency and perioperative medicine is undergoing a transformative shift with the integration of Robotic-Assisted Intubation (RAI). While traditional direct laryngoscopy and Video Laryngoscopy (VL) remain the gold standards, they are inherently limited by human factors, including operator fatigue, varying skill levels, and the physical constraints of difficult airways. Robotic systems ranging from semi-autonomous stylets to fully remote-controlled platforms aim to standardize success rates, minimize soft tissue trauma, and enhance provider safety, particularly in infectious environments.

Robotic-assisted intubation guidelines focus on combining robotic precision with clinician expertise, emphasizing pre-procedure airway assessment (like LEMON/Mallampati), proper system setup (distance, collision avoidance, securement), leveraging visualization (endoscopy), ensuring adequate neuromuscular blockade, using lung-protective ventilation, managing patient positioning (Trendelenburg/head-up), and implementing post-procedure checks (cuff leak, recruitment maneuvers) for improved safety, efficiency, and patient outcomes in complex surgeries. Robotic-Assisted Intubation (RAI) preparation involves standard pre-op patient assessment, NPO guidelines (no food/water after midnight), and potentially bowel prep/medication adjustments, but the key difference lies in specialized equipment like robotic arms, bronchoscopes, and AI guidance for the intubating device, requiring extra training for the anesthesiologist to control the robot for potentially complex airways, with research focusing on automated systems using soft robotics and computer vision for safer, more consistent intubations, especially outside the OR.