Which Videolaryngoscope Should We Use in Airway Management?

Abstract

Aim of review:This review elaborates on the role of different videolaryngoscopes in modern airway management and whether the outcomes of studies on patients and on manikins help anesthesiologists in determining which videolaryngoscope we should prefer. Methods: We reviewed the articles comparing the performance of different videolaryngoscopes published in the last decade. Recent findings: Airway problems that occur during the introduction of general anesthesia in the operating theatre, prehospital, emergency department and intensive care setting are commonly managed by skilled anesthesiologists. However, anticipated and unanticipated difficult airways do occur. Very seldom do these difficult airways result in a "can't ventilate-can't intubate" scenario, with potential death and brain damage as devastating outcomes. Standard Macintosh Laryngoscopy (SML) has its limitations, with Cormack-Lehane grade III-IV and percentage of glottic opening (POGO) scores of 0 being called difficult laryngoscopy. Percent of Intubation success with the direct classic Macintosh blade laryngoscopy (DML), without the use of adjuncts, is often limited to 90% (95% with adjuncts and extra manoeuvers). Videolaryngoscopy offers superiority over direct laryngoscopy as it allows an improved view of the larynx (Cormack-Lehane grade I-II; POGO 50-100% ) and results in an almost 100% intubation success rate with decreased intubation time. In the rare event that an intubation attempt with a Macintosh blade videolaryngoscope (VLS) is not successful, acute angled blades can be used, or a combination technique offers an alternative. The market offers several videolaryngoscopes with alternative options (channelled, non-channelled, acute angled and Macintosh blades), each with their own indications. At this moment, there is no videolaryngoscope available which offers a solution for all problems. With our review we hope to determine the "best" scope, based on publications in the last decade. Summary: Videolaryngoscopes have improved airway management and reduced airway related morbidity and mortality by improving the glottic view (laryngoscopy) and first attempt intubation success. Videolaryngoscopy is useful in video-guided insertion of endotracheal tubes, supraglottic airway devices, temperature probes and nasogastric tubes. However, not all videolaryngoscopes are created equally as there are definite differences which anesthesiologists must be aware of in order to make the best choice for individual patients. This review concluded that the most favored videolaryngoscope was the Pentax-Airway Scope of the channelled videolaryngoscopes and the Karl Storz C-MAC of the non-channelled videolaryngoscopes. However, the C-MAC VLS is the most versatile and can be used for direct and indirect laryngoscopy.

Development and validation of a regression model with nomogram for difficult video laryngoscopy in Chinese population: a prospective, single-center, and nested case-control study

“…Nevertheless, it is also widely accepted for its application during video laryngoscopy, and it remains the best classification criterion for our study due to its representativeness and clinical value. It is important to recognize that Cormack-Lehane grade I and II indicates successful laryngoscopy, whereas grade III and IV indicates failed laryngoscopy ( 30 ).…”