Videolaryngoscopy in Airway Management: What Every Anesthesiologist Should Know!

Abstract

Aim of review:The aim of this article is to convey several hotspot issues regarding the use of videolaryngoscopy (VL) in airway management that anesthesiologists are often concerned. Methods: Recent literature in the past 20 years about the use of VL in the clinical airway management were searched from the Pubmed and Cochrane databases and reviewed, in order to determine the strengths and weakness of VL and conflicting issues regarding the role of VL in airway management. Recent findings: The benefits of VL are most significant in patients with difficult airways, with an improved laryngeal view and an increased success rate of intubation. However, VL cannot give a 100% success rate and there is no specific evaluation system of difficult or failed VL as with direct laryngoscopy. Awake VL-assisted intubation is a useful alternative to awake fiberoptic intubation, but the fiberoptic bronchoscope cannot be discarded and still is gold standard tool of difficult airway management. There are several differenttype VLs available and their efficacies may be different between devices due to various designs and shapes. Due to the limited number of comparative studies, however, there is inconclusive evidence to recommend which VL design is more advantageous in various clinical situations. A Macintosh-type VL allows residents to learn laryngoscopy and intubation more quickly and effectively. Given that VL has tremendous advantages, it should be used as the first-line device for all tracheal intubations. Summary: The introduction of VL has resulted in a dramatic transformation of clinical airway management and is seen as the evolutionary step in intubation technology. There are considerable disagreements over the role of VL in airway management and the need of more investigation, but VL continues to get popularity both inside and outside the operating room. With increasing use of VL in airway management, experience and skill will undoubtedly increase, and the evidence will suggest that the attempt numbers and complications of intubations may be decreased, and patient safety can be improved. (Funded by the Major Project of Zhejiang Science and Technology Fund.) ABSTRACT

Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation – a systematic review and meta-analysis of randomized controlled trials

“… 5 , 44 Although a slim designed McGrath MAC X-blade can be used in patients with restricted mouth opening, 45 a very limited mouth opening can make the use of VL impossible, as “an inter-dental distance of at least 18–20 mm is required to insert even the narrow blades”. 46 , 47 Moreover, some pathologic conditions of the upper airway may prevent success with VL. A large retrospective study of patients with predicted difficult airways showed that the strongest predictors of failed VL were “altered neck anatomy with the presence of a surgical scar, radiation changes, or mass”.…”

Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial

“…Successful intubation requires adequate glottic visualisation and subsequent smooth insertion of the ET tube. [ 10 11 ] The current study showed significantly faster total intubation time using the SAM-VL than McGrath MAC ® laryngoscope. To our knowledge, there is no prior study that directly compared the intubation times between the two.…”

“…The 120 seconds time-limit set was less than the average time for SpO 2 to decrease to 90% during the apnoea following oxygenation with 80% oxygen during induction. [ 10 ] The attending anaesthesiologist would manage the complications accordingly. Management of hypotension and bradycardia were by giving IV fluid boluses (10 ml/kg body weight of Ringer’s lactate), vasopressors (ephedrine 5-10 mg IV bolus), and atropine (0.5 mg IV) if necessary.…”

El-Ganzouri multivariate risk index based airway management in head and neck cancer patients: A retrospective analysis of 1000 patients in a tertiary care center

“…Awake VL has been described in the literature as easier and faster compared to awake FOB[ 13 ] but very limited mouth opening can make the use of VL impossible, as an inter-dental distance of at least 18–20 mm is required to insert even the narrow blades. [ 23 ] Awake VL was not used in the cases studied probably because consultants at our institution feel that conducting, demonstrating, and teaching FOB is more important than awake VL. In the process, they are short of expertise in doing awake VL.…”