Searching for the Perfect Airway Device, too Many Options So Little Time

Abstract

Anesthesiologist used to intubate most of the patients with or without difficult airway in the operatingrooms-and as time passed this translated to people suffering from different conditions that represented an imminent failure to oxygenate properly, most of the times tracheal intubation and mechanical ventilation needed to be started. A difficult airway represents a complex interaction between patient factors, the clinical setting and provider skills [4]. These difficult cases can quickly become emergencies with life-threatening complications or even death. Although rare, the difficult intubation setting presents in the operating rooms presents in 1.15 to 3.8% increasing to a disturbing range of 9 to 12% in the emergency setting outside the OR [5]. As airway management has evolved and other specialists such as intensive care or emergency physicians acquired the responsibility of securing and establishing a patent airway, the risk of doing so in an unstable setting increases the complication rate up to 28% with a mortality of 3% associated with complications such as esophageal intubation, hypoxia, bradycardia and cardiac arrest [6,7]. During training a specialist should undergo at least 57 intubating procedures with a conventional laryngoscope to achieve a 90% success rate [8]. Video assisted intubation was not a popular option at the beginning because of high cost and unpractical rigid designs. Videolaringoscopes utilizes indirect laryngoscopy via its camera improving glottic visualization, usually requiring less force to the base of the tongue and soft tissue [9]. The first popular videolaryngoscope introduced in 2001 to clinical practice was the Glidecope Laryngoscope, Verathon