Advances in Anesthesia: The Role of Videolaryngoscopy in Airway Management

Advances in Anesthesia 31 (2013) 87–98
ADVANCES IN ANESTHESIA
The Role of Videolaryngoscopy in

Airway Management
Michael Aziz, MD
Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Mail Code KPV
5A, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
Keywords
Videolaryngoscopy Airway management Direct laryngoscopy Intubation
Key points
Videolaryngoscopy (VL) has been associated with an ease of intubation difficulty,
and a higher success rate for the patient who is potentially difficult to intubate
than direct laryngoscopy (DL).
Intubation may require less suspension pressure and manipulation of the neck to
achieve successful intubation compared with DL. Furthermore, these benefits
likely extend outside the operating room to the intensive care unit, emergency
medicine, and prehospital care, because these settings are also associated with
difficult airway management.
However, VL may not be superior to DL for routine airway management in the
operating room. Furthermore, VL is not fail proof, and problems related to tube
passage may occur despite an adequate laryngeal view.
Failure can be predicted based on bedside clinical assessment. Caution is
warranted during insertion of videolaryngoscopes as well as during endotra-
cheal tube passage, because pharyngeal injuries after intubation using VL seems
to be a unique problem associated with these devices.
A thorough oral and pharyngeal inspection for airway trauma should be
considered after use of VL for difficult airway management.
DEVICE DESIGNS
Rigid videolaryngoscopy (VL) has been clinically available for many years, but
there has been a significant increase in use over the past 10 years. Advances in
video technology that incorporate complementary metal oxide semiconductor
with light-emitting diode have made videolaryngoscopes more portable, easier
to use, and with improved image quality. Devices are typically categorized as
E-mail address: azizm@ohsu.edu
0737-6146/13/$ – see front matter

http://dx.doi.org/10.1016/j.aan.2013.08.009 Ó 2013 Elsevier Inc. All rights reserved.
Downloaded for FK Universitas Sam Ratulangi (dosenfkunsrat20@gmail.com) at Sam Ratulangi University from ClinicalKey.com by
Elsevier on November 28, 2018. For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights
reserved.
88 AZIZ
those containing a channel for a preloaded tracheal tube (Bullard Elite,

Olympus and Gyrus, Southborough, MA; Pentax AWS, Ambu, Glen Burnie,
MD; King Vision, King Systems, Noblesville, IN) versus those without a
channel (C-MAC, Karl Storz, Tuttlingen Germany; Glidescope, Verathon, Bo-
thell, WA; KingVision; CoPilot VL, McGaw Medical, Fort Worth, TX;
McGrath Series 5, Aircraft Medical, Edinburgh, UK; McGrath MAC, Covi-
dien, Boulder, CO). Although channeled devices overcome some difficulty
with tube passage into the trachea, it may still be difficult to align the trajectory
of the videolaryngoscope with the larynx. The blade designs can be further
categorized as direct laryngoscope blades (ie, Macintosh) versus those with
acute curvatures intended for anterior views of the larynx. The curvature of
the blade may affect the extent of anterior visualization provided by the device.
Devices or their removable blades may come as reusable versus disposable
parts. Accessibility and cost of sterile processing affect the choice of reusable
versus disposable VL equipment.
VL FOR THE UNDIFFERENTIATED AIRWAY

Compared with direct laryngoscopy (DL), laryngeal view is improved when
using VL [1–3]. The improved view may be attributed to a magnified video
view, anterior curvature of laryngoscope blade, video axis extension, or
reduced need to align a direct visual alignment. Although DL is associated
with typically associated intubation failure when a laryngeal view cannot be
achieved, VL frequently overcomes this obstacle. However, improved laryn-
geal view does not necessarily translate to increased intubation success.
Because the success rate for anesthesiologists who perform DL on a normal
airway is high, evidence is yet to show superior effectiveness (regarding intuba-
tion success) of VL to DL for routine airway management [4].
When managing routine airways, VL tends to be a slower intubation tech-
nique. There may be several reasons why providers require more time until
successful intubation when using a VL, including visual attention in 2 different
places, difficult tube passage, and lack of experience with a newer technique.
However, the literature is yet to show that these prolonged intubation times
are associated with an increased incidence of oxygen desaturation or intubation
failure.
WHAT IS THE ROLE OF VL IN THE AIRWAY THAT IS PREDICTED

TO BE DIFFICULT?
An improved laryngeal view translates into improved intubation success for pa-
tients at risk for poor laryngeal view with DL. Although most trials in this re-
gard have not been powered to determine this important outcome of success, a
few of them have reported a reduction in the intubation difficulty scale score
[5,6]. Only a handful of clinical studies so far have defined intubation success
as the primary end point in comparing VL and DL: In a randomized crossover
study, intubation success rates were higher with the Pentax AWS than DL in
patients with artificially applied manual inline stabilization (MILS) [7].
reserved.
THE ROLE OF VIDEOLARYNGOSCOPY 89
Jungbauer and colleagues [8] observed an increased success rate of tracheal

intubation in patients with a raised Mallampati score using VL in a well-
designed randomized controlled trial (RCT). Recently, we conducted a ran-
domized trial exploring a large provider population and broader inclusion of
difficult airway predictors and reported higher intubation success on first
attempt with a video-assisted direct laryngoscope (Storz C-MAC) compared
with DL [9]. Based on these data, evidence emerges that VL can increase intu-
bation success in patients with a predicted difficult airway. However, this the-
ory requires further confirmation by others and may or may not apply to all
intubation environments and VL devices.
WHAT IS THE ROLE OF VL IN THE ENCOUNTERED DIFFICULT

AIRWAY?
Early case reports confirm that VL can be used to rescue an intubation attempt
that has failed with DL [10,11]. In a large 2-center database evaluation of
71,570 perioperative intubations, VL rescued failed DL in 94% (224/239) of
cases [12]. In a study of another VL technique, 99% of (268/270) failed intuba-
tions were successfully rescued after DL failed to offer an adequate laryngeal
view [13]. These studies describing the success of 2 different VL devices as
rescue means for failed airways in a broad patient population involving multi-
ple providers and diverse patient populations indicates that VL performs well
in this troubling patient care situation. For the practitioner, it indicates the
particular benefit of having VL available for the unanticipated difficult airway.
Moreover, because repeated DL attempts are associated with morbidity and
mortality [14,15], it is a constant challenge to improve intubation techniques
and related practice suggestions. The most recent update to the American
Society of Anesthesiologists’ guidelines for the management of the difficult
airway suggests VL as a potential rescue technique after initial failed airway
management [16].
HOW DOES VL COMPARE WITH FLEXIBLE FIBER-OPTIC

INTUBATION FOR THE DIFFICULT AIRWAY?
Only 1 clinical trial has compared awake VL with awake flexible fiber-optic
intubation. In a population of patients deemed difficult to intubate by DL,
VL was compared with flexible fiber-optic intubation. Patients were sedated
with remifentanil and anesthetized with lidocaine topically and via transtra-
cheal injection. The study showed no difference in success rate of tracheal
intubation or intubation time [17]. However, interpretation of the results is
limited because of inappropriate postrandomization exclusions [18], narrow
provider scope of practice, and limited patient inclusion criteria [19]. Future
studies should evaluate VL against flexible awake intubation in a broader
set of patients to clarify the role of VL in awake, as well as asleep, airway
management.
reserved.
90 AZIZ
CAN FAILURE OF VL BE PREDICTED?

Because the predictive value of bedside testing for assessing the risk for difficult
DL is known to be poor, it is unknown if these tests should be used to predict
failure with VL technique. The application of a composite airway assessment
tool, the El-Ganzouri risk index [20], is improved in accuracy when incorpo-
rating VL [21]. So, perhaps difficult intubation can be predicted for VL using
available bedside testing. Tremblay and colleagues [22] identified poor mandib-
ular advancement as a predictor of VL intubation difficulty. However, these
studies did not analyze intubation failure but poor view of the larynx or diffi-
cult tracheal tube passage while using VL as surrogates for intubation difficulty
of the tested devices. In our analysis of 2004 VL intubations, we identified
60 failed intubations with VL and developed a prediction model for failure
[12]. The strongest predictor of failure using this VL device is the patient
with neck disease identified by preoperative physical examination (radiation
changes, masses, or presence of a surgical scar; odds ratio [OR] 4.39, 95% con-
fidence interval [CI] 2:04, 9.46). In addition, we identified operator experience
as a strong predictor (the group of providers with less exposure to the VL had a
higher failure rate; OR 2.28). These data suggest that operator experience in-
fluences the outcome of VL use as it does with other techniques, despite evi-
dence of easy adaptability of this technology. These data also highlight that
although VL is useful in the predicted difficult intubation, certain patient pop-
ulations such as those with neck disease remain at risk for failure using mask
ventilation, DL, or VL. This finding confirms that flexible fiber-optic-guided
intubation remains a hallmark for successful airway management in selected
patient groups. Nevertheless, because a greater proportion of difficult airways
now are approached with VL, many instructors appropriately fear the risk for
inadequate training opportunities in flexible fiber-optic intubation for future
laryngoscopists.
Another frequently encountered problem with VL is the situation of good
laryngeal view but difficult tube passage. As stated earlier, when using VL,
an adequate laryngeal view does not ensure intubation success, particularly
with using acutely curved blades. Although commentaries for various devices
suggest methods to overcome this hurdle, there are no comparative data to sup-
port 1 approach over another. These studies may be an avenue of useful future
research.
Cervical spine mobility

Although VL is useful for the airway predicted to be difficult, the role of VL for
the patient at risk for cervical spine injury deserves attention. Several studies
have addressed the role of VL in the scenario of cervical spine disease by arti-
ficially applying MILS in testing models. These studies are further summarized
in Table 1. Consistently, laryngeal view is improved using VL compared with
DL in the setting of MILS [5,7,23–25]. Furthermore, a more global assessment
of difficult airway management, the intubation difficulty scale score [26], is
improved with VL compared with DL [5,23–25,27]. In one of these many
reserved.
THE ROLE OF VIDEOLARYNGOSCOPY

Table 1
Studies of VL on intubation performance for the patient maintained in manual inline stabilization
Reference Device Control Sample Outcome assessed Major findings
Malik et al [5], 2008 GlideScope DL 120 Laryngeal view Improved laryngeal view and IDS
Pentax IDS Slower intubation time
Intubation time No difference in success
Success rate
Maharaj et al [57], 2008 Airtraqa DL 40 IDS Reduced number of intubation
Intubation attempts attempts. Improved IDS, improved
Laryngeal view laryngeal view
reserved.
Smith et al [25], 1999 WuScope (Pentax, DL 87 IDS Improved IDS and laryngeal view.
Orangeburg, NY) Laryngeal view, intubation No difference in success or
attempts number of attempts
Malik et al [23], 2009 AWS DL 90 IDS, laryngeal view Improved IDS and laryngeal view
Enomoto et al [7], 2008 AWS DL 203 Laryngeal view, intubation time, Improved laryngeal view, increased
success rate success rate, faster intubation time
Liu et al [28], 2009 AWS GlideScope 70 IDS, Intubation time, success rate Faster intubation time, lower IDS,
within a defined time interval improved laryngeal view, and
higher intubation success with
AWS
McElwain & Laffey [27], Airtraqa DL 90 IDS Reduced IDS, improved laryngeal
2011 C-MAC Success rate view with Airtraq
Laryngeal view
Hemodynamic stability
Abbreviation: IDS, Intubation difficulty scale score.
a
Not a videolaryngoscope, but often included in this category.
91
92 AZIZ
studies, intubation success rate is improved with VL compared with DL in the

setting of artificially applied MILS [7]. Performance with a channeled device
was better than an unchanneled device in the setting of MILS [28]. However,
VL may not completely overcome the intubation difficulty related to the appli-
cation of cervical stabilization. In our study of a single videolaryngoscope sys-
tem (Glidescope), we observed that the presence of limited cervical spine
motion either from the application of MILS or existing cervical spine disease
independently predicts VL failure (relative risk 1.76; 95% CI: 1.01, 3.06)
[12]. So, although these devices provide benefit in terms of ease of intubation
and may improve intubation success compared with DL, they are still prone
to failure in the patient with cervical spine disease or precautions.
In terms of cervical motion, several studies have compared VL with DL by
evaluating fluoroscopic images during the intubation procedure (Table 2).
Without the application of MILS, less cervical extension may be necessary
with VL compared with DL [29–32]. However, when MILS is applied, the find-
ings are inconsistent. In some studies, isolated segments of the cervical spine
may realize less cervical extension compared with DL [33–36]; however,
another study reported no difference in cervical motion between VL and DL
when MILS is applied [37].
The studies regarding various airway device approaches to limited cervical
spine motion have yet to show any alterations in neurologic outcomes. The
application of techniques with the highest likelihood of success while maintain-
ing MILS is the best approach. Although flexible fiber-optic intubation may
expose the cervical spine to the least amount of traction, this procedure re-
quires significant skill and a cooperative patient if it is to be performed in the
awake patient. For the anesthetized patient, this procedure still often requires
jaw thrust, which may expose the patient to cervical traction. Videolaryngo-
scopes may be easier to learn than flexible fiber-optic intubation and offer
improvement in terms of intubation difficulty compared with DL. Their use
has increased for the management of the patient with cervical spine
precautions.
Suspension forces
Traumatic effects of laryngoscopy may be evaluated with various other end
points. When pressure transducers are applied to direct and videolaryngo-
scopes, less pressure is exerted on the maxillary incisors during routine intuba-
tion with a video-assisted direct laryngoscope versus DL alone [38]. When
measuring pressures applied to the tongue, less force is required with the Glide-
Scope videolaryngoscope compared with DL [39]. With fewer suspension
forces, there may be less hemodynamic response to VL compared with DL.
However, this hypothesis has mostly been false, because similar hemodynamic
responses are noted with DL and VL [40,41]. Compared with flexible fiber-optic
bronchoscopy, again VL is associated with similar hemodynamic responses [42].
One study has reported a reduction in hemodynamic stimulation and escalation
in bispectral index score during VL compared with DL [43].
reserved.
THE ROLE OF VIDEOLARYNGOSCOPY

Table 2
Studies of cervical motion while using videolaryngoscopes
Study Device Control Cervical precautions Fluoroscopy Major findings
Hastings et al [31], 1995 Bullard DL None In selected patients (C0–C4). Reduced extension across C0–C4)
Angle finder used in the
entire sample
Robitaillie et al [37], 2008 GlideScope DL MILS Continuous C0–C5 during No decrease in cervical movement
several time points
Maruyama et al [29], 2008 AWS DL and McCoy None C1/C2, C3/C4 Reduced extension at adjacent
reserved.
vertebra
Hirabayashi et al [30], 2007 AWS DL None C0–C4 Reduced extension at all segments
Turkstra et al [34], 2005 GlideScope DL MILS C0–C5 Reduced C2–C5 motion with
Lightwand Glidescope. Reduced motion
across all segments with
Lightwand
Watts et al [36], 1997 Bullard DL One arm with MILS C0–C5 Reduced cervical extension in the
One arm without Bullard þ MILS arm
Maruyama et al [33], 2008 AWS DL MILS C0–C4 Reduced cumulative cervical
motion
Turkstra et al [35], 2009 Airtraqa DL MILS C0-thoracic No difference at C1–C2 segment,
less extension at C2–C5, and
C5-thoracic
Kill et al [32], 2013 Glidescope DL None Cranial No difference in crania extension
a
Not a videolaryngoscope, but often included in this category.
93
94 AZIZ
Complications associated with DL

Despite fewer required suspension forces, there is no evidence that airway
trauma is less with VL compared with DL. The literature has produced a large
volume of case reports and discussions around pharyngeal injury associated
with VL. In particular, intubation with the GlideScope has now been associated
with soft palate or pharyngeal injury during tube passage [12,44–53]. Particular
caution is warranted when passing the tracheal tube during VL especially with
unchanneled devices. It is plausible that providers’ attention is inappropriately
diverted from the patient to view a video screen during VL; however, that
attention should be turned back to the patient during tracheal tube passage un-
til the tube can be clearly seen on the VL monitor.
Prehospital scenarios
Several observational studies of prehospital VL have been performed. In a
European medical system, the C-MAC VL was successful in 80 tracheal intu-
bations either when used with video assistance or as a direct laryngoscope
when lens contamination occurred [54]. In a before-and-after study of a busy
air medical unit in the United States, the GlideScope offered faster intubation
times with fewer intubation attempts than DL, although with similarly high
success rates. Carlson and colleagues [55] analyzed metrics of successful preho-
spital VL and determined that successful intubations were associated with
improved laryngeal views and faster times to laryngeal view than unsuccessful
video attempts.
Prospective randomized data are limited, but 1 such study has been conduct-
ed in a European medical system. Trimmel and colleagues [56] enrolled 212
prehospital patients into a randomized comparison of DL versus Airtraq laryn-
goscopy. The success rate for DL was 99% versus 47% in the Airtraq laryngos-
copy group. This remarkably poor performance of the optical laryngoscope is
interesting. In controlled operating room settings, this device performs remark-
ably well compared with DL, even in the setting of cervical spine mobilization
or other predictors of difficult intubation [24,57]. This device design does not
use video-empowered optics, but rather prisms with a light source to reflect an
anterior laryngeal view through an eyepiece. The unique situations of pre-
hospital emergency care may have resulted in excessive lens contamination.
Furthermore, ambient natural light with difficult provider orientation to the
optical piece may have compromised the providers’ capacity to visualize the
airway. Prehospital RCTs are difficult to conduct, but it is clear that the exist-
ing data are inadequate to guide care. Well-designed studies of commonly used
videolaryngoscopes in the hands of the routine prehospital providers are
urgently needed to determine if this technology can improve care of the pre-
hospital patient.
Emergency medicine
More recently, the use of VL has increased for emergency medicine use. Early
observational studies reported less frequent use of VL compared with DL and
similar success rates when the techniques were compared [58–60]. However,
reserved.
these studies did not evaluate the nature of patient selection for the various
techniques studied. In more recent observational studies, VL seems to be
used more frequently overall, and with the greatest frequency in the patient
predicted to be difficult to intubate by DL. For patients with predictors of diffi-
cult DL, success rates seem to be higher for VL compared with DL across mul-
tiple institutions [59]. In a study by Sakles and colleagues, 38% of patients were
intubated with VL to achieve a higher first-attempt success rate than DL [58].
In another study by Sakles and colleagues, a different videolaryngoscope was
used in 34% of emergency intubations to show a higher overall intubation suc-
cess rate with VL compared with DL [59]. Similarly, Mosier and colleagues [61]
reported a higher success rate with VL (78%) compared with DL (68%) for
emergency airway management even when VL was used more frequently in
those with predictors of difficult DL. It seems that the use of VL for airway
management of the patient with trauma in the emergency department is
increasing in frequency. Furthermore, these data suggest that more frequent
use of these new devices by emergency medicine providers can translate to
increased intubation success compared with DL. However, VL has been inad-
equately tested in a prospective randomized fashion for the patient with emer-
gency medicine trauma.
SUMMARY
VL has been associated with an ease of intubation difficulty, and a higher suc-
cess rate for the patient potentially difficult to intubate than with DL. Intuba-
tion may require less suspension pressure and manipulation of the neck to
achieve successful intubation compared with DL. Furthermore, these benefits
likely extend outside the operating room to the intensive care unit, emergency
medicine, and prehospital care, because these settings are also associated with
difficult airway management. However, VL may not be superior to DL for
routine airway management in the operating room. Furthermore, VL is not
fail proof and problems related to tube passage may occur despite an adequate
laryngeal view. Failure can be predicted based on bedside clinical assessment.
Caution is warranted during insertion of videolaryngoscopes as well as during
endotracheal tube passage because pharyngeal injuries after intubation using
VL seem to be a unique problem associated with these devices. A thorough
oral and pharyngeal inspection for airway trauma should be considered after
use of VL for difficult airway management.
References
[1] Cooper RM, Pacey JA, Bishop MJ, et al. Early clinical experience with a new videolaryngo-
scope (GlideScope) in 728 patients. Can J Anaesth 2005;52:191–8.
[2] Kaplan MB, Hagberg CA, Ward DS, et al. Comparison of direct and video-assisted views
of the larynx during routine intubation. J Clin Anesth 2006;18:357–62.
[3] Suzuki A, Toyama Y, Katsumi N, et al. The Pentax-AWS((R)) rigid indirect video laryngo-
scope: clinical assessment of performance in 320 cases. Anaesthesia 2008;63:641–7.
[4] Sun DA, Warriner CB, Parsons DG, et al. The GlideScope video laryngoscope: random-
ized clinical trial in 200 patients. Br J Anaesth 2005;94:381–4.
reserved.
96 AZIZ
[5] Malik MA, Maharaj CH, Harte BH, et al. Comparison of Macintosh, Truview EVO2, Glide-
scope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.
Br J Anaesth 2008;101:723–30.
[6] Malik MA, Subramaniam R, Maharaj CH, et al. Randomized controlled trial of the Pentax
AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation. Br J
Anaesth 2009;103:761–8.
[7] Enomoto Y, Asai T, Arai T, et al. Pentax-AWS, a new videolaryngoscope, is more effective
than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck
movements: a randomized comparative study. Br J Anaesth 2008;100:544–8.
[8] Jungbauer A, Schumann M, Brunkhorst V, et al. Expected difficult tracheal intubation: a pro-
spective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J
Anaesth 2009;102:546–50.
[9] Aziz MF, Dillman D, Fu R, et al. Comparative effectiveness of the C-MAC video laryngo-
scope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesi-
ology 2012;116:629–36.
[10] Shippey B, Ray D, McKeown D. Use of the McGrath videolaryngoscope in the manage-
ment of difficult and failed tracheal intubation. Br J Anaesth 2008;100:116–9.
[11] Cooper RM. Use of a new videolaryngoscope (GlideScope) in the management of a diffi-
cult airway. Can J Anaesth 2003;50:611–3.
[12] Aziz MF, Healy D, Kheterpal S, et al. Routine clinical practice effectiveness of the Glide-
scope in difficult airway management: an analysis of 2,004 Glidescope intubations, com-
plications, and failures from two institutions. Anesthesiology 2011;114:34–41.
[13] Asai T, Liu EH, Matsumoto S, et al. Use of the Pentax-AWS in 293 patients with difficult air-
ways. Anesthesiology 2009;110:898–904.
[14] Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed
claims analysis. Anesthesiology 2005;103:33–9.
[15] Mort TC. Emergency tracheal intubation: complications associated with repeated laryngo-
scopic attempts. Anesth Analg 2004;99:607–13.
[16] Apfelbaum JL, Hagberg CA, Caplan RA, et al, American Society of Anesthesiologists Task
Force on Management of the Difficult Airway. Practice guidelines for management of the
difficult airway: an updated report by the American Society of Anesthesiologists Task Force
on Management of the Difficult Airway. Anesthesiology 2013;118:251–70.
[17] Rosenstock CV, Thogersen B, Afshari A, et al. Awake fiberoptic or awake video laryngo-
scopic tracheal intubation in patients with anticipated difficult airway management: a ran-
domized clinical trial. Anesthesiology 2012;116:1210–6.
[18] Todd MM, Bayman EO. Fiberoptic versus videolaryngoscopic management of the difficult
airway: problems with postrandomization patient exclusion. Anesthesiology 2013;118:460.
[19] Levine AI, Leibowitz AB. Flexible bronchoscopy still the definitive standard for airway man-
agement. Anesthesiology 2013;118:461.
[20] el-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative airway assessment: predictive
value of a multivariate risk index. Anesth Analg 1996;82:1197–204.
[21] Cortellazzi P, Minati L, Falcone C, et al. Predictive value of the El-Ganzouri multivariate risk
index for difficult tracheal intubation: a comparison of Glidescope videolaryngoscopy and
conventional Macintosh laryngoscopy. Br J Anaesth 2007;99:906–11.
[22] Tremblay MH, Williams S, Robitaille A, et al. Poor visualization during direct laryngos-
copy and high upper lip bite test score are predictors of difficult intubation with the Glide-
Scope videolaryngoscope. Anesth Analg 2008;106:1495–500.
[23] Malik MA, Subramaniam R, Churasia S, et al. Tracheal intubation in patients with cervical
spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh
laryngoscopes. Br J Anaesth 2009;102:654–61.
[24] Maharaj CH, Buckley E, Harte BH, et al. Endotracheal intubation in patients with cervical
spine immobilization: a comparison of Macintosh and Airtraq laryngoscopes. Anesthesi-
ology 2007;107:53–9.
reserved.
[25] Smith CE, Pinchak AB, Sidhu TS, et al. Evaluation of tracheal intubation difficulty in patients
with cervical spine immobilization: fiberoptic (WuScope) versus conventional laryngos-
copy. Anesthesiology 1999;91:1253–9.
[26] Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and
evaluation of a new score characterizing the complexity of endotracheal intubation. Anes-
thesiology 1997;87:1290–7.
[27] McElwain J, Laffey JG. Comparison of the C-MAC(R), Airtraq(R), and Macintosh laryngo-
scopes in patients undergoing tracheal intubation with cervical spine immobilization. Br J
Anaesth 2011;107:258–64.
[28] Liu EH, Goy RW, Tan BH, et al. Tracheal intubation with videolaryngoscopes in patients
with cervical spine immobilization: a randomized trial of the Airway Scope and the Glide-
Scope. Br J Anaesth 2009;103:446–51.
[29] Maruyama K, Yamada T, Kawakami R, et al. Upper cervical spine movement during intu-
bation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macin-
tosh laryngoscope. Br J Anaesth 2008;100:120–4.
[30] Hirabayashi Y, Fujita A, Seo N, et al. Cervical spine movement during laryngoscopy using
the Airway Scope compared with the Macintosh laryngoscope. Anaesthesia 2007;62:
1050–5.
[31] Hastings RH, Vigil AC, Hanna R, et al. Cervical spine movement during laryngoscopy with
the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology 1995;82:859–69.
[32] Kill C, Risse J, Wallot P, et al. Videolaryngoscopy with Glidescope reduces cervical spine
movement in patients with unsecured cervical spine. J Emerg Med 2013;44:750–6.
[33] Maruyama K, Yamada T, Kawakami R, et al. Randomized cross-over comparison of
cervical-spine motion with the AirWay Scope or Macintosh laryngoscope with in-line sta-
bilization: a video-fluoroscopic study. Br J Anaesth 2008;101:563–7.
[34] Turkstra TP, Craen RA, Pelz DM, et al. Cervical spine motion: a fluoroscopic comparison
during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth
Analg 2005;101:910–5.
[35] Turkstra TP, Pelz DM, Jones PM. Cervical spine motion: a fluoroscopic comparison of the Air-
Traq laryngoscope versus the Macintosh laryngoscope. Anesthesiology 2009;111:97–101.
[36] Watts AD, Gelb AW, Bach DB, et al. Comparison of the Bullard and Macintosh laryngo-
scopes for endotracheal intubation of patients with a potential cervical spine injury. Anes-
thesiology 1997;87:1335–42.
[37] Robitaille A, Williams SR, Tremblay MH, et al. Cervical spine motion during tracheal intu-
bation with manual in-line stabilization: direct laryngoscopy versus GlideScope videolar-
yngoscopy. Anesth Analg 2008;106:935–41.
[38] Lee RA, van Zundert AA, Maassen RL, et al. Forces applied to the maxillary incisors during
video-assisted intubation. Anesth Analg 2009;108:187–91.
[39] Russell T, Khan S, Elman J, et al. Measurement of forces applied during Macintosh direct
laryngoscopy compared with GlideScope(R) videolaryngoscopy. Anaesthesia
2012;67:626–31.
[40] Siddiqui N, Katznelson R, Friedman Z. Heart rate/blood pressure response and airway
morbidity following tracheal intubation with direct laryngoscopy, GlideScope and Trach-
light: a randomized control trial. Eur J Anaesthesiol 2009;26:740–5.
[41] Xue FS, Zhang GH, Li XY, et al. Comparison of hemodynamic responses to orotracheal intu-
bation with the GlideScope videolaryngoscope and the Macintosh direct laryngoscope.
J Clin Anesth 2007;19:245–50.
[42] Xue FS, Zhang GH, Li XY, et al. Comparison of haemodynamic responses to orotracheal
intubation with GlideScope videolaryngoscope and fibreoptic bronchoscope. Eur J Anaes-
thesiol 2006;23:522–6.
[43] Nishikawa K, Matsuoka H, Saito S. Tracheal intubation with the PENTAX-AWS (airway
scope) reduces changes of hemodynamic responses and bispectral index scores
compared with the Macintosh laryngoscope. J Neurosurg Anesthesiol 2009;21:292–6.
reserved.
98 AZIZ
[44] Vincent RD Jr, Wimberly MP, Brockwell RC, et al. Soft palate perforation during orotracheal
intubation facilitated by the GlideScope videolaryngoscope. J Clin Anesth 2007;19:
619–21.
[45] Nestler C, Reske AP, Reske AW, et al. Pharyngeal wall injury during videolaryngoscopy-
assisted intubation. Anesthesiology 2013;118:709.
[46] Leong WL, Lim Y, Sia AT. Palatopharyngeal wall perforation during Glidescope intubation.
Anaesth Intensive Care 2008;36:870–4.
[47] Hsu WT, Hsu SC, Lee YL, et al. Penetrating injury of the soft palate during GlideScope intu-
bation. Anesth Analg 2007;104:1609–10.
[48] Hirabayashi Y. Pharyngeal injury related to GlideScope videolaryngoscope. Otolaryngol
Head Neck Surg 2007;137:175–6.
[49] Dupanovic M. Maneuvers to prevent oropharyngeal injury during orotracheal intubation
with the GlideScope video laryngoscope. J Clin Anesth 2010;22:152–4.
[50] Cross P, Cytryn J, Cheng KK. Perforation of the soft palate using the GlideScope videolar-
yngoscope. Can J Anaesth 2007;54:588–9.
[51] Cooper RM. Complications associated with the use of the GlideScope videolaryngoscope.
Can J Anaesth 2007;54:54–7.
[52] Choo MK, Yeo VS, See JJ. Another complication associated with videolaryngoscopy. Can J
Anaesth 2007;54:322–4.
[53] Chin KJ, Arango MF, Paez AF, et al. Palatal injury associated with the GlideScope. Anaesth
Intensive Care 2007;35:449–50.
[54] Cavus E, Callies A, Doerges V, et al. The C-MAC videolaryngoscope for prehospital emer-
gency intubation: a prospective, multicentre, observational study. Emerg Med J 2011;28:
650–3.
[55] Carlson JN, Quintero J, Guyette FX, et al. Variables associated with successful intubation
attempts using video laryngoscopy: a preliminary report in a helicopter emergency med-
ical service. Prehosp Emerg Care 2012;16:293–8.
[56] Trimmel H, Kreutziger J, Fertsak G, et al. Use of the Airtraq laryngoscope for emergency
intubation in the prehospital setting: a randomized control trial. Crit Care Med
2011;39:489–93.
[57] Maharaj CH, Costello JF, Harte BH, et al. Evaluation of the Airtraq and Macintosh laryn-
goscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia
2008;63:182–8.
[58] Lim HC, Goh SH. Utilization of a Glidescope videolaryngoscope for orotracheal intuba-
tions in different emergency airway management settings. Eur J Emerg Med
2009;16(2):68–73.
[59] Choi HJ, Kang HG, Lim TH, et al, Korean Emergency Airway Management Registry
(KEAMR) Investigators. Endotracheal intubation using a GlideScope video laryngoscope
by emergency physicians: a multicentre analysis of 345 attempts in adult patients. Emerg
Med J 2010;27:380–2.
[60] Platts-Mills TF, Campagne D, Chinnock B, et al. A comparison of GlideScope video laryn-
goscopy versus direct laryngoscopy intubation in the emergency department. Acad Emerg
Med 2009;16:866–71.
[61] Mosier JM, Stolz U, Chiu S, et al. Difficult airway management in the emergency depart-
ment: GlideScope Videolaryngoscopy compared to direct laryngoscopy. J Emerg Med
2012;42(6):629–34.
reserved.

Advances in Anesthesia: The Role of Videolaryngoscopy in Airway Management

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Advances in Anesthesia: The Role of Videolaryngoscopy in Airway Management

Uploaded by

Copyright:

Available Formats

Advances in Anesthesia 31 (2013) 87–98

The Role of Videolaryngoscopy in

E-mail address: azizm@ohsu.edu

0737-6146/13/$ – see front matter

those containing a channel for a preloaded tracheal tube (Bullard Elite,

VL FOR THE UNDIFFERENTIATED AIRWAY

WHAT IS THE ROLE OF VL IN THE AIRWAY THAT IS PREDICTED

Jungbauer and colleagues [8] observed an increased success rate of tracheal

WHAT IS THE ROLE OF VL IN THE ENCOUNTERED DIFFICULT

HOW DOES VL COMPARE WITH FLEXIBLE FIBER-OPTIC

CAN FAILURE OF VL BE PREDICTED?

Cervical spine mobility

THE ROLE OF VIDEOLARYNGOSCOPY

studies, intubation success rate is improved with VL compared with DL in the

THE ROLE OF VIDEOLARYNGOSCOPY

Complications associated with DL

You might also like