Evaluation of intubating adjuncts to videolaryngoscopy in a simulated difficult airway: A manikin cross-over study

Further developing the evidence base for videolaryngoscopy

“…Recently, Vowles and colleagues evaluated the use of different intubating adjuncts to videolaryngoscopy (VL) in a simulated difficult airway. 1 The authors should be congratulated for investigating one of the key questions regarding the use of VL in clinical practice, namely which adjunct is most appropriate for facilitating intubation with a specific VL device, and in a specific clinical scenario. This question sits alongside the consideration as to which VL device best suits the variety of specific airway challenges encountered in clinical practice, as being an area of some uncertainty.…”

“…Vowles and colleagues simulated a difficult airway, with an inflated tongue, a fixed neck, and an anteriorly displaced larynx, features which would understandably hinder attempts to bring the oral, pharyngeal, and laryngeal planes into alignment, and potentially favour the use of a hyperangulated blade. 1 Anaesthetists and intensivists manage the airway in a range of situations where the challenges posed, and thus the indications for VL, will vary. Arguably, given the increasing access to VL devices and the selection available to the airway practitioner, the evidence should evolve to consider the interplay of specific device features with individual airway challenges.…”

“…Their primary outcome was time to intubation, which was found to be shortest with the Frova introducer (Cook Medical, Bloomington, IN, USA), compared with the flexible tip bougie (Construct Medical, Melbourne, Victoria) and flexible bronchoscope (Ambu aScope, Ballerup, Denmark) (33.2 versus 34.9 versus 44.8 seconds, P <0.05). 1…”

“…Vowles and colleagues simulated a difficult airway, with an inflated tongue, a fixed neck, and an anteriorly displaced larynx, features which would understandably hinder attempts to bring the oral, pharyngeal, and laryngeal planes into alignment, and potentially favour the use of a hyperangulated blade. 1 Anaesthetists and intensivists manage the airway in a range of situations where the challenges posed, and thus the indications for VL, will vary.…”

“…Their primary outcome was time to intubation, which was found to be shortest with the Frova introducer (Cook Medical, Bloomington, IN, USA), compared with the flexible tip bougie (Construct Medical, Melbourne, Victoria) and flexible bronchoscope (Ambu aScope, Ballerup, Denmark) (33.2 versus 34.9 versus 44.8 seconds, P<0.05). 1 Choice of both specific VL device and adjunct is of considerable importance, and will have a profound impact on the success of airway management. Echoing the call for more evidence regarding the marriage of certain VL devices with specific airway challenges, the appropriate selection of intubating adjunct, for device and airway, should be considered.…”