Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy

Abstract

Safety and population pharmacokinetic analysis of intravenous acetaminophen in neonates, infants, children, and adolescents with pain or Fever.

Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation

“…If it is now essential to maximise the first attempt success rate, and if it is the case that videolaryngoscopes yield higher success in visualising the glottis [12], then it follows that these should become first line devices in most if not all tracheal intubations [13,14]. The guidelines do state that videolaryngoscopy can be used as first-line, but we would go further with this logic.…”

Postoperative sore throat: The importance of the position of the airway device

“…Some methods of intervention used for orotracheal intubation to reduce the incidence of postoperative sore throat include: a) adequate pre-oxygenation of the lungs and adequate positioning of the patient before induction of anesthesia by raising the head 5-10cm with a block, ring or pillow to allow flexion of the neck or the ramped position in obese patients; b) use of vision-guided insertion of ETTs, whereby the ETT is guided towards the vocal cords and trachea; c) use of a videolaryngoscope which has a wider angle of view (60°), as opposed to the classic laryngoscope (15°) [8], which allows better laryngoscopy views and results in higher first attempt intubation success rates; d) insertion of the tube should be gentle, avoiding any trauma to the oropharynx/larynx; e) the vocal cord guide (one or two black lines on the wall of the ETT) should be placed adequately at the level of the trachea so that the tip of the ETT is positioned above the bifurcation while the cuff sits just down the vocal cords but not across the vocal cords; f) adequate inflation of the pilot cuff gives an airtight seal however, it is important to ensure that the intracuff pressure of ETT is limited to 15-30 cm H 2 0, avoiding both under-and overpressure, also during maintenance of anesthesia; g) if possible, the use of BURP (backward upward and rightwards pressure) and cricoid pressure manoeuvres should be avoided as both result in a significant decrease in the area under the vocal cord opening, and hence contribute to the trauma of the vocal cords during forced intubation; h) adequate anesthesia, including muscle relaxants and pain relief, is important to consider; i) practitioners should try to limit the number of attempts, use a non-traumatic intubation technique and ask for assistance in difficult cases; j) the use of airway adjuncts (e.g. Magill forceps, Frova intubating bougie) is an important consideration and having rescue airway devices (plan A-B-C) ready at hand is highly important.…”

“…It allows a gentle intubation technique under indirect vision on a monitor screen. Videolaryngoscopy should be used to insert all airway devices, including ETTs, SADs, nasogastric and orogastric tubes and temperature probes [7][8][9][10]. Only by visual confirmation of the exact position of all airway devices, a further reduction in the incidence of postoperative sore throat can be realized.…”

Unexpectedly difficult airway

“…Ako je po novom vodiču od esencijalne važnosti maksimizirati uslove da prvi pokušaj intubacije bude uspešan, onda videolaringoskop treba da postane oprema za prvu liniju izbora, u većini, ako ne i u svim trahealnim intubacijama, jer više studija dokazuje njegovu superiornost u vizualizaciji glotisa [7,8,9]. Ventilacija facijalnom maskom Vodič iz 2015. je eksplicitan oko sledeće nove preporuke; nakon preoksigenacije, ventilaciju facijalnom maskom, 100% kiseonikom, treba započeti što pre, odmah nakon anestezije, a pre aplikovanja miorelaksanata, "jer će anesteziolog već tada znati koliko je lako ili teško ventilirati na masku", što će mu dati dovoljno informacija da, ukoliko je potrebno, naglo promeni odluku o strategiji i na obezbeđenja disajnog puta.…”