Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis

Abstract

The incidence of difficult and failed intubation is higher in obstetrical patients than in the general population because of anatomic and physiologic changes in pregnancy. Videolaryngoscopy improves the success rate of intubation and reduces complications when compared with direct laryngoscopy in adults; however, it is not known whether this extends to obstetrical surgery. The aim of this study was to examine the efficacy, efficiency, and safety of videolaryngoscopy compared with direct laryngoscopy in obstetrics. Source Central, CINAHL, Embase, MEDLINE and Web of Science databases were searched from inception to 27 May 2020 with no restrictions. Inclusion criteria included randomized-controlled trials (RCTs), observational studies, case series, and case reports that reported the application of videolaryngoscopy to intubate the trachea in pregnant patients having general anesthesia. Principal findings Overall, four RCTs with 428 participants, nine observational studies, and 35 case reports/series with 100 participants were included. On meta-analysis of three trials, the co-primary outcomes of first-attempt success rate (risk ratio, 1.02; 95% confidence intervals [CI], 0.98 to 1.06; P = 0.29; I 2 = 0%) and time to tracheal intubation (mean difference, 1.20 sec; 95% CI,-6.63 to 9.04; P = 0.76; I 2 = 95%) demonstrated no difference between videolaryngoscopy and direct laryngoscopy in parturients without difficult airways. Observational studies and case reports underline the role of videolaryngoscopy as a primary choice when difficulty with tracheal intubation is expected or as a rescue modality in difficult or failed intubations. Conclusions Evidence for the utility of videolaryngoscopy continues to evolve but supports its increased adoption in obstetrics where videolaryngoscopes should be immediately available for use as a first-line device. Trial registration PROSPERO (CRD42020189521); registered

General Anesthetic and Airway Management Practice for Obstetric Surgery in England: A Prospective, Multicenter Observational Study

“…The authors discuss how national survey data reveal VL capabilities are only present in 55% of obstetric units in the United Kingdom. If true, this is a pressing need that must be addressed, given the increasing support in the literature for VL as being a useful tool in the management of parturients with expected difficult intubation or failed intubation by other methods (eg, direct laryngoscopy) 1. Indeed, in my view the debate in obstetric anesthesia has shifted away from whether VL should be available in obstetric units (it should!…”

Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic

“…Airway management and tracheal intubation in ICU setting are associated with a higher risk of adverse events, with a complication rate up to 45%, which can explain such high availability rate [ 2 , 19 ]. High VL availability in general surgery and gynecology/obstetrics areas is related to the greater incidence of difficult airway in emergency general surgery as well as in pregnant patients [ 20 , 21 ]. These results are in concordance with UK study.…”

General anesthesia for cesarean section: are we doing it well?

“…The usefulness of VL has already been demonstrated in adults who require intubation [ 39 ] and especially in obese patients [ 40 ]. This supports its increased adoption in obstetrics, where VL, rather than direct laryngoscopy, is recommended as the first attempt at intubation for all obstetric patients [ 36 , 41 ].…”