Recent advances in laryngoscopy in adults

Abstract

Recent advances in technology have made laryngoscopy less dependent upon a direct line of sight to achieve tracheal intubation. Whether these new devices are useful tools capable of increasing patient safety depends upon when and how they are used. We briefly consider the challenges in reviewing the emerging literature given the variety of devices, “experience” of the care providers, the clinical settings, and the definitions of outcome. We examine some of the limitations of conventional direct laryngoscopy, question the definitions we have used to define success, discuss the benefits of indirect (video) techniques, and review evidence pertaining to their use in the patients in the operating room, emergency department, and intensive care unit.

Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting

“…This suggests a potential benefit to utilizing VL even when difficult intubation has not been anticipated [10,11]. VL is increasingly recommended and used as part of the first-line strategy in routine intubation cases [10,13,23,24], and there is evidence supporting its benefits in patients with non-difficult airways [25].…”

Letter to the Editor: video laryngoscopy – the new de facto standard in intubation

“…Success or failure of intubation technique depends on the metrics that we use. Early analysis [4] was binary, success or failure, irrespective of the number of attempts, duration of the effort, amount of force utilized and the laryngeal view obtained. Degree of difficulty was not included.…”

“…Degree of difficulty was not included. Improved pre-intubation metrics [4] for anatomic airway assessment improved recognition of subjects likely to be problematic. Later analysis [5] focused on ergonomics and the force, both axial and perpendicular, applied by the laryngoscopist, which reached 70% of peak values.…”

“…Later analysis [5] focused on ergonomics and the force, both axial and perpendicular, applied by the laryngoscopist, which reached 70% of peak values. Later analysis [4] extending to progressively larger retrospective and prospective sample sizes, was outcome oriented, examining the entire spectrum of resultant major and minor complications, such as: sore throat, dental trauma, trauma to integument, intensive care unit admissions, brain injury, need for a surgical airway or death. DL fails to optimize laryngeal view in up to 6% of patients without apparent anatomic abnormalities, results in mild (38%) and moderate (8%) intubation difficulties and requires more than three intubation attempts in 3% of patients [4].…”

“…Later analysis [4] extending to progressively larger retrospective and prospective sample sizes, was outcome oriented, examining the entire spectrum of resultant major and minor complications, such as: sore throat, dental trauma, trauma to integument, intensive care unit admissions, brain injury, need for a surgical airway or death. DL fails to optimize laryngeal view in up to 6% of patients without apparent anatomic abnormalities, results in mild (38%) and moderate (8%) intubation difficulties and requires more than three intubation attempts in 3% of patients [4]. Subsequent technical advances included the development of the laryngeal mask airway, variants, laryngeal mask airway knock-off devices, supraglottic airways and more recently, the development of the VL.…”