Advances in Laryngoscopy.

Michael Aziz

doi:10.12688/f1000research.7045.1

Abstract

Recent technological advances have made airway management safer. Because difficult intubation remains challenging to predict, having tools readily available that can be used to manage a difficult airway in any setting is critical. Fortunately, video technology has resulted in improvements for intubation performance while using laryngoscopy by various means. These technologies have been applied to rigid optical stylets, flexible intubation scopes, and, most notably, rigid laryngoscopes. These tools have proven effective for the anticipated difficult airway as well as the unanticipated difficult airway.

Highlights

Airway management remains a difficult skill to master
One study across two centers demonstrated that rescue using the GlideScope video laryngoscope was successful in 94% of cases (224/239) after failed direct laryngoscopy[26]
In summary, video laryngoscopy has established a permanent role in difficult airway management

Summary

Introduction

Airway management remains a difficult skill to master. Competency requires didactic instruction as well as hands-on training with simulators and human patients. As success rates for tracheal intubation using direct laryngoscopy in experienced hands are very high, there does not seem to be added benefit beyond improvement of laryngeal view for the undifferentiated airway across age spectrums[5,6]. Findings may not apply to the true “awake” intubation Despite these limitations, awake video laryngoscopy may be a tool that is easier to learn and master than flexible bronchoscopic intubation and likely has a future role in awake airway management. In critical care and emergency medicine environments, video laryngoscopy was associated with a higher intubation success rate in patients with predictors of difficult direct laryngoscopy[10,17,18,19]. Video laryngoscopy has been used for emergency airway management, potential difficult intubations, and rescue of failure of direct laryngoscopy[22]. Studies have not shown a clear difference in success rate between various blade design types[33,34]

Conclusions

Findings

30. Aziz M