Videolaryngoscopy

Learning objectives

Videolaryngoscopy utilizes video camera technology to visualize airway structures and facilitate endotracheal intubation
Videolaryngoscopy is an alternative to direct laryngoscopy for airway intubation in adults and children as it improves airway safety and is associated with fewer failed attempts and complications
Is also a new diagnostic and therapeutic tool in head and neck surgery
Has the great advantage of reducing difficult views of the laryngeal opening (glottis)
Despite a good view of the cords, difficulty may be encountered in advancing the tube through the glottis with videolaryngoscopy
Use the mnemonic aid “CCL” to prepare for videolaryngoscopy:
- Choose the right tube
- Check the endotracheal tube cuff
- Lubricate the stylet and the endotracheal tube
- Load the stylet (band it according to the angle of the videolaryngoscopy blade)
Consider the possibility of airway trauma during videolaryngoscopy as the operator’s attention is diverted from the direct view of the proximal airway to the indirect view of the glottis on the monitor
Therefore, introduce the tip of the tube and stylet into the oropharynx under direct vision and then advance as guided by the indirect view on the monitor

Advantages	Disadvantages
Easier to learn and maintain the skill (by observing the video screen) Effective tool for those who infrequently intubate as well as students learning to intubate	Succes rate is not 100%
Less workforce is needed to view the glottis Improved glottic visualization	Unknown efficacy in routine airway management and the efficacy of different videolaryngoscopes differs
A higher first-pass success rate of tracheal intubation in patients with difficult airways versus direct laryngoscopy and thus a lower incidence of multiple attemts	A higher incidence of oropharyngeal injury
Superior view of the glottic opening versus direct laryngoscopy	Prolonged intabution time due to difficult tracheal tube delivery into the glottic opening
A lower incidence of inadvertent esophageal intubation versus direct laryngoscopy	The camera view can frequently be blurred by foging, secretions, blood, or emesis in the oropharynx
Easier to confirm pathological changes (laryngeal edema) after repeated attempts at trachel intubation	Two-dimensional view with loss of depth perception
It is not necessary to align airway axes (oral-pharyngeal-laryngeal) to achieve line of sight	More expensive and still not widely available
Less cervical manipulation	Potential weakening in development/maintenance of direct laryngoscopy skill set
Possible awake assessment/intubation	Potential for false sense of security and lack of preparation for a difficult airway