Video Laryngoscope Research Articles

A skill lab training experience with truview video laryngoscope in different airway scenarios using an adult manikin

A skill lab training experience with truview video laryngoscope in different airway scenarios using an adult manikin

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

Glottic opening detection using deep learning for neonatal intubation with video laryngoscopy.

This study aimed to develop an artificial intelligence (AI) method to augment video laryngoscopy (VL) by automating the detection of the glottic opening in neonates, as a step toward future studies on improving intubation outcomes. A deep learning model, YOLOv8, was trained on 1623 video frames from 84 neonatal intubations to detect the glottic opening and evaluated using 14-fold cross-validation on metrics like precision and recall. Additionally, it was compared with 25 medical providers of varied intubation experience to assess its relative performance. The model demonstrated a precision of 80.8% and a recall of 75.3% in identifying the glottic opening, detecting it 0.31 s faster than the average medical provider. It performed comparably or better than novice and intermediate providers, and slightly slower than experts. AI-powered tools can aid VL by providing real-time guidance, potentially enhancing neonatal intubation safety and efficiency for less experienced users.

Effects of GlideScope, Pentax Airway Scope, and Macintosh Blade on the incidence of postoperative sore throat: a cohort study of 9,881 patients.

Postoperative sore throat (POST) is a common complaint after general anesthesia. POST is defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat after general anesthesia. This condition may affect recovery and patient satisfaction and is associated with many factors, including intubation tools. Previous studies have reported conflicting results on POST. This retrospective cohort study, with sample size of 9,881 patients, was conducted to confirm the hypothesis that the use of video laryngoscopy (VL) is associated with a lower incidence of POST compared with direct laryngoscopy (DL). Data were extracted from a prospectively maintained quality improvement database. A total of 9,881 patients were included in the study. Statistical analysis was conducted for comparisons of demographic characteristics and to determine the effect of intubation tools on the incidence of POST. The patients had similar baseline demographic characteristics. Compared with DL, VL was associated with a lower incidence of POST (12.98% vs. 17.49%, P < 0.001). In addition, the use of Pentax Airway Scope (AWS) was associated with a lower incidence of POST compared with the use of GlideScope (GVL, 8.14% vs. 16.25%, P < 0.001). To better adjust for possible confounding factors, mixed-effects generalized linear model analysis revealed that older age (odds ratio [OR]: 0.995, 95% confidence interval [CI]: 0.992-0.999, P = 0.006), AWS compared to DL (OR: 0.416, 95% CI: 0.350-0.494, P < 0.001), and male sex (OR: 0.836, 95% CI: 0.747-0.935, P = 0.002) are associated with reduced incidence of POST. Compared with DL, VL is associated with a lower incidence of POST. In addition, the use of AWS is associated with a lower incidence of POST compared with the use of GVL. Retrospectively registered, NCT06515808, date of registration: 23/07/2024.

A visual laryngoscope combined with a fiberoptic bronchoscope improves intubation outcomes in patients with predicted difficult airways in thoracic surgery

ObjectiveTo study the clinical effectiveness of visual laryngoscopy combined with fiberoptic bronchoscopy-guided double-lumen endotracheal tube intubation in thoracic surgery patients with predicted difficult airways in thoracic surgery airways.MethodsWe randomly divided 162 patients with predicted difficult airways who required double-lumen tracheal intubation for thoracic surgery and randomly divided them into the video laryngoscopy group (Group VL, n = 54),fiberoptic bronchoscopy group (Group F, n = 54), and video laryngoscopy combined with fiberoptic bronchoscopy group (Group FVL, n = 54) according to the randomized number table method. Then, the success rate of the first intubation, the duration of intubation, the duration of positioning, the degree of exposure of the vocal cords (Cormack-Lehane grade), and the adverse reactions during intubation were recorded and analyzed.ResultsThe success rate of first-time intubation was significantly higher in the FVL group than in the F and VL groups (92.6% vs. 87.0% vs. 53.7%, P < 0.001), and the time of intubation in the FVL group was significantly shorter than that in the VL and F groups [(26.22 ± 9.34) s vs. (42.35 ± 11.21) s vs. (46.78 ± 21.96) s, P < 0.001)]. The positioning time in the FVL group was significantly shorter than that in the F and VL groups [(83.76 ± 15.18) s vs. (102.72 ± 21.89) s vs. (145.41 ± 20.12) s, F = 144.896, P < 0.001)].The number of patients with Cormack-Lehane grades I-II was significantly lower in the FVL group and the VL group than in the F group (88.9% vs. 77.8% vs. 59.3%, P < 0.05).The incidence of postoperative sore throat was significantly lower in the FVL group and the F group than in the VL group (22.4% vs. 27.6% vs. 50%, P < 0.001).ConclusionIn difficult airway patients with high airway risk indices who require double-lumen endotracheal intubation, visual laryngoscopy combined with fiberoptic bronchoscopy improved the success rate of first-time intubation and shortened the intubation and positioning time.Trial registrationChinese Clinical Trial Register (identifier: ChiCTR2300076304; Date of registration: September 29, 2023).

Rethinking the utility of comparative studies between direct and video laryngoscopy in neonates and infants.

Rethinking the utility of comparative studies between direct and video laryngoscopy in neonates and infants.

Comparison of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients

Background: Development of video laryngoscope has made management of airway easier. 0ur study was aimed to compare the efficacy of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients under general anesthesia. Objectives: The primary objective of the study was to compare the glottic view obtained , the need for external manipulation, endotracheal tube insertion time and attempts taken for successful intubation with Macintosh laryngoscope and King Vision video laryngoscope. The secondary objective was to estimate the changes in hemodynamic parameters and to evaluate the occurrence of complications during intubation. Materials and Methods: The study included 136 patients posted for surgery under general anesthesia. Patients were randomly allocated in group C (N=68) and group V (N=68 ).Endotracheal intubation was done in group C by Macintosh and in group V by King Vision video laryngoscope. Laryngoscopy was assessed by Cormack Lehane grading and the need for any manipulation. The intubation time was calculated with each blade. Hemodynamic parameters were recorded and any complication during laryngoscopy and intubation were noted. The observations were analysed statistically by SPSS Program for windows version 28. Results: In group C, 61.8% of patients had Cormack and Lehane score I while in group V 76.5 % of patients had score I . Mean time of successful intubation was 34.90±8.35 sec in group C while in group V it was 32.82± 5.20 second . There was no statistical difference in distribution of patients according to number of attempts of intubation. In group C, 64.7% of patients needed external laryngeal pressure while in group V 97.1 % patients were intubated without external laryngeal pressure. Both the groups were comparable in relation to changes in hemodynamic parameters and any complications associated with laryngoscopy and intubation. Conclusion: We conclude that glottic view is better obtained with King Vision Video laryngoscope whereas optimisation of position and external laryngeal manipulation is often required with Macintosh laryngoscope to get similar glottic view. Introduction of King Vision video laryngoscope into the oral cavity takes time but intubation is easier with it. Hemodynamic variables and complications during the procedure are equally distributed between the two devices.

Impact of universal use of the McGrath videolaryngoscope as the first option for all intubations in the operating room: The multicentre prospective before-after VIDEOLAR-SURGERY study protocol

IntroductionStandard tracheal intubation performed in the operating room is based on direct laryngoscopy using a standard Macintosh laryngoscope. Several authors recommend the universal use of a video laryngoscope as the first option for all intubations, regardless of whether the patient has predictors of a difficult airway or not. We hypothesize that using the McGrath video laryngoscope as the first intubation option increases the frequency of patients with easy intubation, and decreases intubation-related complications. Methods and analysisThe VIDEOLAR-SURGERY trial is a prospective, multicentre, open-label, interventional, before-after study. In the pre-implementation period (non-interventional phase, 6-9 months [2600 intubations]), 35 anaesthesiologists from 8 hospitals perform all tracheal intubations for an elective or urgent surgical procedure using the standard Macintosh direct laryngoscope as the first intubation option. During the implementation period (2 months), each anaesthesiologist is given a McGrath Mac video laryngoscope and trained in its use. During the post-implementation period (interventional-phase, 6-9 months [2600 intubations]), the 35 anaesthesiologists perform all tracheal intubations using a McGrath Mac video laryngoscope as the first intubation option. The main objective of this study is to evaluate whether the use of a McGrath Mac video laryngoscope as the first intubation option increases the percentage of patients with easy intubation compared with the standard Macintosh laryngoscope. Ethics and disseminationThe study protocol was approved on 2 May 2023 by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2023-177), and was registered on the Clinicaltrials.gov clinical trials registry under No. NCT NCT05850260. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If video laryngoscopy improves easy intubation compared with Macintosh direct laryngoscopy in all operating room intubations, its use may well become standard practice, thereby decreasing the risks of intubation-related complications.

Comparison of hemodynamic responses to orotracheal intubation with Tuoren video laryngoscope and Macintosh direct laryngoscope in adult hypertensive patients

Comparison of hemodynamic responses to orotracheal intubation with Tuoren video laryngoscope and Macintosh direct laryngoscope in adult hypertensive patients

Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrathTM video laryngoscope: a prospective randomized trial.

Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. This controlled trial randomized fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects. The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type. Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.

Anesthetic Management of a Child with Frontonasal Encephalocele and Hemifacial Microstomia Syndrome for Repair of Encephalocele and Microstomia Correction

AbstractAnesthetic management of a child with hemifacial microstomia and frontonasal encephalocele can be challenging due to factors such as a difficult airway, associated systemic conditions, young age, and prolonged operating time. Hereby, we outline the intraoperative management of a 3-year-old child undergoing repair of multiple defects requiring multidisciplinary involvement of neurosurgery, plastic surgery, and anesthesia team. In our case, a size 0 mask and hyper-angulated D-blade video laryngoscopy were used to prevent sac compression and facilitate intubation. Blood conservation strategies included tranexamic acid, precise fluid management, and maintenance of normothermia. Extubation was carefully planned, considering blood loss and airway edema, and performed when the child was fully awake, ensuring a stable postoperative period and successful recovery. This report emphasizes the importance of meticulous preoperative assessment, readiness for a challenging airway, efficient management of intraoperative blood loss, and the value of teamwork.

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials

Objectives: Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults. Design: A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG). Setting: Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet. Patients: Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU. Interventions: None. Measurements and Main Results: A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds (sd, 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (–4.4 s compared with nondiabetes; 95% CI, –17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation (p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52). Conclusions: Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.

Video Laryngoscopy in Critically Ill Adults: Nascent, Evolving, or Established?*

Video Laryngoscopy in Critically Ill Adults: Nascent, Evolving, or Established?*

Anesthetic management of a patient with mandibular hypoplasia, deafness, progeroid features, lipodystrophy syndrome: a case report

BackgroundMandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a rare autosomal dominant disorder that presents unique challenges for anesthetic management due to its multisystemic manifestations. This report outlines the anesthetic considerations for MDPL patients based on our case experience.Case presentationA 15-year-old male with MDPL syndrome underwent testicular extraction under general anesthesia. Insertion of a peripheral venous catheter was challenging due to scleroderma-like skin. Although the facial features of MDPL syndrome suggested a difficult airway, intubation with a McGrath™ Mac video laryngoscope was successful. Despite MDPL syndrome’s association with hypertriglyceridemia due to lipodystrophy, this patient’s triglyceride levels were normal. Thiamylal and sevoflurane were used without issues such as delayed emergence from anesthesia.ConclusionsMDPL syndrome requires careful preoperative assessment and tailored anesthetic management due to potential airway challenges arising from its distinctive facial features and the possibility of altered anesthetic pharmacokinetics associated with lipodystrophy.

Adapting general anaesthesia for a patient with class III obesity and obstructive sleep apnoea undergoing day case laparoscopic cholecystectomy: A case report.

This report describes the anaesthesia provided for a class III obese patient with obstructive sleep apnoea, undergoing an elective laparoscopic cholecystectomy. Several adaptations were required to provide safe anaesthesia. A McGrath video laryngoscopy was utilised for intubation. The patient was positioned in the ramped position, thereby increasing time to desaturation on induction of anaesthesia. Pressure controlled ventilation - volume guaranteed mode was selected for ventilation to provide consistent tidal volumes. An increased level of positive end-expiratory pressure was utilised to minimise atelectasis. Drug doses were carefully considered and calculated with the aid of The Society for Obesity and Bariatric Anaesthesia dose calculator. The airway management adaptations provided an unobstructed view for intubation. Peak airway pressures during surgery remained within safe limits and no atelectasis was evident postoperatively. Pain was kept under control and desaturation was avoided during postanaesthetic care. The patient was discharged home later that evening.

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

Changes in practice of less-invasive surfactant administration (LISA) in United Kingdom neonatal units.

To determine whether the use of less-invasive surfactant administration (LISA) had changed between 2018 and 2024. An online questionnaire was sent to all 191 neonatal units between June 2023 and May 2024. One consultant from each neonatal unit was randomly selected. Follow-up was done by telephone (middle-grade doctor grade and above or alternatively to Advanced Neonatal Nurse Practitioners) for the non-responders. Response rate was 100%from 191 units neonatal units. LISA was used in 134 (70%) neonatal units in 2024 compared to 35 (18.7%) units in 2018 (p < 0.001). The reason why LISA was not performed was lack of experience/training (51%) or not having a standardised practice/guideline (49%). LISA in the delivery suite (DS) had increased from 2% in 2018 to 16% in 2024, and the use of video laryngoscope for LISA is becoming standard of practice. The oxygen requirement criteria for the use of LISA in both the DS and on neonatal unit had reduced to FiO2 of 0.3 or more. The uptake of LISA had increased in the United Kingdom. There is greater use of LISA in the DS. Lack of training and expertise were the major limiting factors for LISA not being performed.

Evaluating the Impact of Direct, Direct Video, and Indirect Video Laryngoscopy Training on the Proficiency of Medical Students in Performing Direct Laryngoscopy: A High-Fidelity Manikin-Based Assessment.

Endotracheal intubation (ETI), a potentially lifesaving intervention employed frequently in the emergent setting, is a manual skill that improves with repetitive practice and high-quality feedback. Classically, ETI centered around Direct Laryngoscopy (DL); however, with the advent and recent availability of Indirect Video Laryngoscopy (IVL) and Direct Video Laryngoscopy (DVL), studies have demonstrated varying results on the benefit of Video Laryngoscopy (VL) in training. We hypothesize that a training program centered on DVL, allowing students to visualize the anatomy and simultaneously receive instructor feedback via a real-time video feed, will practically improve student performance in DL. Our study of first-year medical students from the Edward Via College of Osteopathic Medicine (n = 21) randomized participants to one of three cohorts: DL, IVL, and DVL in a manikin-based simulation laboratory evaluated on successful intubation, time to successful intubation, dental injury, Numeric Rating Scale (NRS) to assess the trainee's perception of their performance and confidence level of performing intubation in a real-life scenario. Our results did not demonstrate a statistically significant difference between the three training modalities based on the outcomes assessed. Although IVL and DVL cohorts achieved 100% success following training, compared to 71% in the DL cohort, the results were not statistically significant. This is potentially due to our limited sample size, as our sample did not meet the calculated 162 participants for 80% power. These findings suggest that a larger sample size may be required to determine if there is a significant difference in outcomes for these training modalities.

Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials

BackgroundThe role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical...