Background: Video laryngoscope (VLs) has become a mandate in airway management. Every VLs have a unique design that warrants the need for intricate analysis and research concerning its efficacy. Aims and Objectives: This prospective randomized controlled trial was designed to compare the performance of channeled King Vision VLs (KVVLs) and hyperangulated CMAC-D blades for endotracheal intubation in head and neck surgeries. Materials and Methods: Institutional Ethical Clearance and Clinical Trials Registry-India registration were obtained. Informed consent of 110 patients of American Society of Anesthesiologists classification I and II, aged between 18 and 59 years of either gender was taken, and was randomly allocated into two groups. Standard induction for general anesthesia was given. Patients were intubated using either of two VLs. The primary outcome was mean time taken for intubation, and secondary outcomes were ease of intubation by intubation difficulty scoring, hemodynamic response following laryngoscopy, intubation, and their associated complications. Results: The total time taken for intubation was comparable between both KVVLs and CMAC-D blade (30.45±6.53 s, 27.85±9.04 s; P=0.087). Glottic visualization by percentage of glottic opening scoring was significantly better with the CMAC-D blade (P=0.049). The need for assist maneuvers and alternate techniques was more required by KVVLs than CMAC-D blades (P=0.004 and 0.028, respectively). The intergroup hemodynamic variables and complications associated with laryngoscopy were not statistically significant. Conclusion: Both KVVLs and CMAC-D blades were equally efficient in managing the airway in head and neck surgeries. KVVLs offer practical advantages making it ideal for resource-limited settings, with its performance remaining uncompromised even in absence of a CMAC-D blade.

Extramedullary Plasmacytoma (EMP) belongs to the category of haematolymphoid neoplasms of the larynx. This is a case report of a 51-year-old female patient who presented to the Ear, Nose and Throat (ENT) department with a change in voice and a swelling in the neck. On video laryngoscopy, a smooth bulge was observed arising from the right ventricle towards the midline. Magnetic Resonance Imaging (MRI) of the neck showed a large, relatively well-defined T1 hypointense, T2 and T2 FS hyperintense, mildly enhancing mass centred in the right lamina of the thyroid cartilage. Histopathology reported plasmacytoma with CD138 positivity and lambda restriction. Although EMP in the supraglottic region has been reported, plasma cell neoplasm involving the thyroid cartilage is extremely rare. Reaching such a rare diagnosis requires a collaborative effort, where each clinical and diagnostic finding plays a crucial role in achieving accuracy

Multimodal laryngoscopic video analysis for assisted diagnosis of vocal fold paralysis

ABSTRACT The use of laryngoscopy is widespread in the field of airway management, providing improved visual clarity and procedural support in various clinical situations. Endotracheal intubation (ETI) is commonly employed during general anesthesia and the subsequent recovery period. This work employs a focused methodology to investigate algorithms for improving video quality in real‐world clinical situations and to build algorithms for detecting glottis and larynx in video laryngoscopy. The main objective is to mechanize the capture and archiving of video‐assisted intubation. The heuristic strategy involves capturing the ETI video and subsequent preprocessing utilizing 2‐D FIR filtering, adaptive histogram equalization, Gaussian filtering with varying sigma values, and artificial intelligence improving techniques. Video quality was assessed using no‐reference: NIQE, BRISQUE and full‐reference: PSNR metrics. Additionally, a video frame's quality is calculated using XAI. LoG, contrast, edge density, entropy and brightness are taken into account for the video quality score, with weights taken into account as per [0.35, 0.25, 0.2, 0.1, 0.1]. Subsequently, a suitable model was developed to ascertain the optimal approach for enhancing video quality during ETI. A lower NIQE coefficient leads to improved visibility. Optimizing the video quality selection can enhance the success rate of challenging intubations on the initial attempt. Next, the data will be analyzed for application in educational, training, and simulation settings.

Background: Osteoradionecrosis (ORN) following head and neck radiotherapy has been demonstrated to induce structural and functional alterations of the upper airway, with the potential to complicate the process of tracheal intubation. Despite its clinical relevance, there is a paucity of systematic evidence on airway characteristics in ORN and reliable predictors of difficult tracheal intubation. This study compares preoperative airway parameters and tracheal intubation outcomes in irradiated patients with and without ORN and introduces a novel preoperative ORN-Difficult-Airway Score for risk stratification. Methods: In this retrospective cohort study, airway assessments, tracheal intubation methods, and perioperative visualization parameters were evaluated in 105 patients following head and neck radiotherapy. Group differences between non-ORN and ORN were analyzed using chi-square tests. A preoperative ORN-Difficult-Airway Score was constructed using exclusively bedside parameters, based on statistically and clinically relevant predictors. Results: Patients with ORN showed significantly restricted mouth opening (p < 0.001), higher Mallampati classes, particularly Mallampati IV, and a greater need for fiberoptic tracheal intubation (p < 0.01). Direct laryngoscopy (DL) was significantly less feasible in ORN, while hyperangulated videolaryngoscopy (VL) yielded consistently positive visualization (first-pass success (FPS) 100% in both groups). Under DL, FPS was lower in ORN (54.2% vs. 79.5%), resulting in an odds ratio of 0.305. Based on observed predictors, ORN status, mouth opening <3 cm, Mallampati class, restricted neck reclination, and history of difficult intubation, a preoperative ORN-Difficult-Airway Score was developed. Conclusions: ORN has been associated with distinct alterations in airway anatomy and visualization, resulting in increased tracheal intubation complexity after head and neck radiotherapy. The proposed ORN-Difficult-Airway Score presents a clinically practical, bedside-applicable approach to stratifying the risk of tracheal intubation in this population. Prior to clinical implementation, prospective validation in larger cohorts is warranted.

The 2025 Consensus on Science with Treatment Recommendations summary developed by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation includes recommendations on neonatal resuscitation issued between 2021 and 2025. Major updates address umbilical cord management at birth, thermoregulation and other initial steps of resuscitation, interfaces and devices for providing positive pressure ventilation, oxygen therapy during neonatal resuscitation, the use of video laryngoscopy for endotracheal intubation, and the application of monitoring devices in the delivery room. Several good practice statements have been added, while certain previous recommendations such as the use of sodium bicarbonate in the delivery room have been withdrawn.

Airway management is central to the care of critically ill patients, yet it remains one of the most challenging interventions in emergency departments and intensive care units. Patients often present with severe physiological instability, limited cardiopulmonary reserve, and high acuity, while clinicians often work under constraints related to time for preparation, equipment availability, trained workforce, monitoring, and access to advanced rescue techniques. These challenges are particularly pronounced in low- and middle-income countries and other resource-limited or austere environments, where the margin for error is narrow and delays or repeated attempts in airway management may rapidly precipitate hypoxemia, hemodynamic collapse, or cardiac arrest. Although contemporary airway guidelines emphasize structured preparation and rescue pathways, many assume resources that are not consistently available in such settings. This narrative review discusses pragmatic, context-adapted strategies for airway management in constrained environments, with emphasis on physiology-first preparation, appropriate oxygenation and induction techniques, simplified rapid-sequence intubation, and the judicious use of basic airway adjuncts, supraglottic devices, and video laryngoscopy, where available. Adapted difficult airway algorithms, front-of-neck access in the absence of surgical backup, human factors, team training, and ethical considerations are also addressed. This review aims to support safer and effective airway management for critically ill patients in resource-limited emergency and intensive care settings.

Rediscovering Retrograde Intubation: A Classic but Indispensable Technique in the Era of Video Laryngoscopy.

Abstract Background Endotracheal intubation (ETI) during massive hematemesis is challenging due to airway contamination. The suction‐assisted laryngoscopy and airway decontamination (SALAD) technique has shown promising results in manikin studies involving emergency doctors, but its effectiveness and feasibility with Hong Kong paramedics, for whom ETI is not a standard practice, remains unexplored. Objectives This study aimed to compare the efficacy of a simplified SALAD technique using a DuCanto catheter versus a conventional technique with a Yankauer suction catheter during paramedic‐performed ETI in a simulated massive hematemesis scenario, while assessing its feasibility for Hong Kong's prehospital system. Methods A randomized crossover manikin study was conducted involving 34 paramedics from the Fire Services Department, Hong Kong Special Administrative Region. Participants performed intubations using both techniques on a high‐fidelity manikin simulating massive hematemesis. Primary outcome was the first attempt intubation success rate. Secondary outcomes included intubation time, aspiration volume, esophageal intubation rate, and participants' perceptions via 5‐point Likert scales. Results SALAD‐1 demonstrated superior performance across multiple metrics including first attempt intubation success rate (73.5% vs. 52.9% and p = 0.078), intubation time (50.56 vs. 58.73 s and p = 0.033), and aspiration volume (22.06 vs. 286.32 mL and p < 0.001). Esophageal intubation occurred in three cases with the conventional method but in none with SALAD‐1, a difference that was not statistically significant ( p = 0.119). Participant feedback strongly favored SALAD‐1 across all evaluation domains (mean scores 4.5–4.79/5 vs. 2.91–3.44/5 and p < 0.001). Conclusions This study provides preliminary evidence that the SALAD technique can be rapidly acquired and effectively applied by Hong Kong paramedics in a simulated setting, demonstrating both clinical advantages and strong operator acceptance. These findings support the integration of SALAD into future paramedic training curricula and warrant further clinical research.

Introduction: Laryngoscopy and tracheal intubation inevitably trigger a sympathoadrenal response, manifesting as tachycardia and hypertension. While video laryngoscopy (VL) offers improved glottic visualization compared to direct laryngoscopy (DL), its efficacy in specifically attenuating this hemodynamic stress remains a subject of debate. This study investigates whether VL provides superior hemodynamic stability during the critical post-intubation period by analyzing the rate pressure product (RPP) and temporal hemodynamic interactions. Methods: In this prospective, single-blind, randomized controlled trial, 40 adult patients (ASA I-II) undergoing elective surgery were allocated to either Group VL (GlideScope, n=20) or Group DL (Macintosh, n=20). Anesthesia was strictly standardized with Fentanyl 2 mcg/kg, Propofol 2 mg/kg, and Atracurium 0.5 mg/kg. Hemodynamic parameters, including systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR), were recorded at baseline (T0) and at 1 (T1), 2 (T2), and 5 (T5) minutes post-intubation. The primary analysis utilized a general linear model (Repeated Measures ANOVA) to assess Time-Group interactions, corrected for sphericity. Results: Demographics were homogeneous between groups. A significant Time-Group interaction was observed for MAP (p less than 0.001), indicating a blunted pressor response curve in the VL group. Heart Rate at 1-minute post-intubation was significantly lower in Group VL (75.45 plus or minus 11.23 bpm) compared to Group DL (90.15 plus or minus 15.22 bpm; p equals 0.001). Analysis of the rate pressure product revealed that Group DL approached ischemic thresholds, whereas Group VL maintained significantly lower myocardial workload at minutes 1 and 2 (p less than 0.01). Conclusion: Video laryngoscopy significantly attenuates the reflex tachycardia and arterial pressure surge associated with tracheal intubation compared to direct laryngoscopy. VL is recommended to minimize cardiovascular stress in susceptible surgical populations.

Background: During tracheal intubation using video laryngoscopy, manipulating the tracheal tube may be challenging because of misalignment between the camera’s visual axis and the curvature of the tube, which can hinder smooth tube advancement and potentially increase the risk of airway trauma. A channeled laryngoscope blade, which allows the tube to be preloaded and guided directly along the visual axis, may facilitate easier intubation and reduce soft tissue injury, thereby offering a potential advantage over conventional blades. This study compared the performance of channeled and conventional blades for tracheal intubation using video laryngoscopy. Methods: In this prospective randomized controlled trial, 140 adult patients undergoing elective spine surgery were randomly assigned to intubation with either a conventional blade (Group Co) or a channeled blade (Group Ch). The primary outcome was the intubation time, measured from the insertion of the laryngoscope to confirmation of successful tracheal intubation. Secondary outcomes included the initial intubation success rate and intubation-related complications, such as bleeding, sore throat, and hoarseness. Results: Baseline characteristics were comparable between the two groups. The median intubation time was longer in Group Ch (20.7 s) than in Group Co (19.5 s, p = 0.008). However, the initial success rate and the incidence of intubation-related complications were similar between the two groups. Conclusions: The channeled blade was associated with a slightly longer intubation time but demonstrated a similar success rate and safety profile compared to the conventional blade. Both blade types showed comparable clinical performance, suggesting that the choice between them may be guided by operator preference. Clinical Trial Registration: NCT04948294, retrospectively registered.

Tracheal intubation using video laryngoscopy as compared to direct laryngoscopy during cardiopulmonary resuscitation: a systematic review and meta-analysis.

We report the case of a 51‐year‐old male who experienced transient unilateral hypoglossal nerve palsy (HNP) after undergoing elective shoulder surgery under general anesthesia. Tracheal intubation was performed using a C‐MAC D‐Blade video laryngoscope (Karl Storz). Intubation was uneventful, with clear visualization of the vocal cords corresponding to a Cormack–Lehane Grade I view, no airway trauma was visible. Shortly after extubation, the patient complained of tongue swelling, dysarthria, and dysphagia. Clinical examination confirmed an isolated ipsilateral HNP. A brain and neck MRI conducted 4 h postoperatively showed no structural abnormalities along the hypoglossal nerve pathway, and an otolaryngological assessment identified no additional lesions. The patient was managed conservatively, including supportive speech therapy, and made a complete recovery within 14 weeks. This case report highlights a rare incidence of isolated HNP, which occurred in a patient with prior cervical spine fusion and obesity during video laryngoscopy. Possible contributing factors include compression or stretching of the hypoglossal nerve due to airway manipulation, patient positioning, or instrumentation in proximity of cicatrized cervical soft tissue. It is the first case report of HNP following video laryngoscopy with complete recording of the video laryngoscopy. Although video laryngoscopy enhances visual access during intubation, clinicians should remain cautious about potential localized tissue and nerve stress, particularly when using hyperangulated blades. This case highlights that video laryngoscopy does not inherently guarantee reduced soft tissue trauma when compared with traditional direct laryngoscopy.

Intubating conditions based on the time from rocuronium administration versus the train-of-four count: A randomized, prospective, clinical trial.

BackgroundVideo laryngoscopes improve tracheal intubation success, but evidence comparing channeled devices (TAScope- The anaesthetic society scope) with non-channeled video laryngoscopes is limited. This prospective randomized controlled trial evaluated their comparative efficacy and safety. Objectives Primary: Compare the number of intubations attempts between channeled (TAScope) and non-channeled video laryngoscopes. Secondary: Assess intubation time, frequency of additional maneuvers, hemodynamic changes, and airway complications. MethodsTwo hundred adult patients undergoing elective surgery under general anesthesia were randomly assigned to TAScope (n = 100) or a non-channeled video laryngoscope (n = 100). Data were collected prospectively by blinded research personnel. Statistical analyses included chi-square, t-tests, Mann-Whitney U tests, and repeated measures ANOVA (p < 0.05). ResultsThe median number of intubation attempts was significantly lower with TAScope (1 [IQR: 1–1]) versus the non-channeled device (2 [IQR: 1–3]; p < 0.001). Intubation times were comparable (38.5 ± 6.2 seconds for TAScope vs. 40.1 ± 7.8 seconds; p = 0.08). TAScope required fewer additional maneuvers (22% vs. 45%; p < 0.001) and caused less pronounced hemodynamic changes post-intubation (p < 0.05). Airway complications were less frequent with TAScope (8%) than the non-channeled device (18%; p = 0.03). Subgroup analysis showed TAScope performed better in difficult airways (Mallampati ≥3 or Cormack-Lehane ≥3). ConclusionTAScope demonstrated superior performance over non-channeled video laryngoscopes, with fewer intubation attempts, reduced need for additional maneuvers, better hemodynamic stability, and fewer complications. These findings suggest TAScope may be advantageous in anticipated difficult airways or for less experienced operators.

Objectives: Tracheal intubation is a critical airway management skill frequently performed by resident physicians, yet the literature comparing video laryngoscopy and direct laryngoscopy in this trainee population remains limited. Previous studies highlight differences in success rates, complications, and visualization quality between both techniques, but their applicability to real-world resident training requires further exploration. We aimed to compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy for tracheal intubation performed by residents at a tertiary care cardiac hospital in Karachi. Methodology: This non-randomized comparative observational study enrolled 166 adult patients undergoing tracheal intubation from September 2023 to February 2024. Participants were assigned to either video laryngoscopy (Group-V) or direct laryngoscopy (Group-D) based on consecutive sampling. Efficacy was defined as first-attempt success, and safety was assessed by the absence of complications such as desaturation, aspiration, soft-tissue injury, bronchospasm, or esophageal intubation. Results: Each group comprised 83 patients. Group-V demonstrated a significantly higher first-attempt success rate (78.3%) than Group-D (59.0%) (p = 0.007) and required fewer attempts (1.24 ± 0.46 vs. 1.42 ± 0.52; p < 0.001). Complication-free intubation was also more frequent in Group-V (68.7%) compared to Group-D (53.0%) (p = 0.039). Conclusion: Video laryngoscopy was associated with superior efficacy and a more favorable safety profile compared with direct laryngoscopy in resident-performed intubations. These findings support the integration of video laryngoscopes into residency training programs to enhance airway management skills and reduce adverse events.

Video laryngoscope versus disposcope endoscope for anticipated laryngeal tumor related difficult intubation in patients undergoing general anesthesia: a randomized controlled trial

Oesophageal intubation is dangerous if not promptly identified and managed. It often results from human error and inadequate education. An advanced technologies can mitigate the risk of this serious complication and enhance patient safety. This narrative review evaluated contemporary publications concerning unrecognised oesophageal intubation in the surgical theatre. PubMed, Scopus, and the Cochrane Library were searched for relevant articles published from 2010 to 2025, excluding non-English manuscripts, case reports, and studies lacking pertinent data. The effectiveness of capnography, video laryngoscopy, and simulation training was analysed to determine intubation rates across various clinical settings. The narrative review indicated that the rates of unrecognised oesophageal intubation range from 2.9% to 16.7%, and are associated with increased mortality. The implementation of video laryngoscopy reduced these rates by approximately 50%, while simulation training improved first-attempt intubation success. The findings underscore the necessity of incorporating advanced monitoring systems and simulation-based training into anaesthesia protocols to reduce the risks associated with overlooked oesophageal intubation. This fosters a safety-oriented culture and utilises technological innovations to significantly improve patient outcomes and decrease the incidence of this severe complication.

Unilateral vocal fold paralysis (UVFP) due to recurrent laryngeal nerve (RLN) injury is a common cause of dysphonia. No biotherapeutic injectable exists that directs laryngeal reinnervation after RLN injury. Placental-derived connective tissue matrix (pd-CTM) could fill this need, as it contains a plethora of cytokines with potential UVFP therapeutic benefits. This study aimed to identify and quantify the factors in a commercially available pd-CTM (CTM Flow, CTM Biomedical, Lake Worth, Florida) and to study the effects of pd-CTM on vocal fold microenvironment and glottic function in a mouse model of unilateral RLN injury. Cytokine expression (ng/mL) in pd-CTM was characterized using a cytokine array and ELISA. In a separate experiment, C57/BL6 mice were divided into three groups: uninjured negative controls (n = 12), RLN transection with ipsilateral saline thyroarytenoid (TA) injection (n = 16), and RLN transection with ipsilateral pd-CTM TA injection. Outcomes included laryngeal electromyography (L-EMG) and video laryngoscopy after 7 and 28 days, with larynges then harvested and analyzed via immunohistochemistry (IHC) and qPCR. pd-CTM characterization showed moderate-to-high levels of neurotrophic (BDNF, CNTF, GDNF, NTF-3), angiogenic (Angiogenin, VEGF-D), tissue remodeling (bFGF, IGF-1, HGF, TGF-β3), and anti-inflammatory factors (IL-10, IL-1Rα). L-EMG demonstrated increased mean normalized area under the curve ratio in pd-CTM treated mice compared to saline treated mice at the 28-day time point indicating reinnervation (p < 0.001). IHC detected innervated neuromuscular junctions 28 days after pd-CTM treatment. pd-CTM may be a novel treatment option for patients with UVFP based on the neurotrophic, angiogenic, tissue remodeling, and anti-inflammatory factors present. NA.

We aimed to compare the 72-hour survival of the endotracheal intubation (ETI) with video laryngoscope (VL), ETI with direct laryngoscope (DL), and supraglottic airway (SGA) in out-of-hospital cardiac arrest (OHCA) patients in Korea. This study included adult OHCA patients who received advanced airway management by designated response teams for severe disease, using a nationwide OHCA registry in South Korea from July 2019 to December 2021. The primary outcome was 72-hour survival, and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression was used, adjusted for confounders, to compare the outcomes among the three airway management methods. Among 77,629 OHCA cases, 10,857 were included. SGA was attempted in 9,379 cases, ETI with DL in 493 cases, and ETI with VL in 985 cases. The rates of any prehospital ROSC and 72-hour survival were 13.3% and 11.0% for SGA, 16.0% and 11.4% for ETI with DL, and 18.2% and 11.9% for ETI with VL. Compared to SGA, ETI with VL was significantly associated with 72-hour survival: adjusted odds ratio (OR) [95% confidence interval (CI)] 1.34 (1.06-1.70) for ETI with VL and 1.13 (0.81-1.56) for ETI with DL). There was no significant association between the type of AAM and survival to discharge or good neurological recovery. In an emergency medical service system staffed by advanced emergency medical technician-level providers, ETI with VL might be associated with improved 72-hour survival compared to SGA. However, this short-term benefit did not extend to survival to hospital discharge.