Videolaryngoscopy 2.0

February 2, 2022

Written by Aaron Lacy

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Video laryngoscopy (VL) has been around for over 20 years and a lot has changed. When discussing VL, it’s important to get terminology right, but it’s even more important to know how to use it.

Why does this matter?
Many consider VL standard of care, and there are many types of VLs to choose from. VL technology has rapidly expanded and changed in the last 2 decades, and it is important to understand the current landscape of this technology. This editorial is partly to urge us to change the descriptors we use. But we’re covering it because it is an excellent review of current VL technology.

Let’s talk about VL
The authors of this paper seek to offer a term for modern video laryngoscopy. While they choose the term “Videolaryngoscopy 2.0,” which would help in literature and research situations, more importantly, it’s meant to promote the idea that the generic term “VL” is inappropriate and nondescript.

Blades: During the advent of VL, indirect laryngoscopy was achieved with a hyperangulated blade. Now there are both hyperangulated and standard geometry blades, and documentation should be descriptive of the type of blade. Using the term “Glidescope” or “C-MAC” to refer to your VL is not descriptive enough anymore, as brands which were previously synonymous with one device now have multiple VLs of varying size, geometry, and tech specs. An example of an appropriate description for documentation and talking to colleagues would be “We intubated the patient using a standard geometry C-MAC 3 VL.”

Tube Delivery: Tube delivery and stylets needed (bougie also an option) vary between different devices, in particular those with hyperangulated blades. Become facile with the tube, tube angle needed, and any proprietary stylets that are paired with the VL at your shop. Reminder: With hyperangulated blades and corresponding highly curved, preformed stylets, you or an assistant will usually need to back out the stylet once you pass the cords in order to pass the tube. Otherwise, it bumps against the anterior trachea and will not pass.

VL Limitations: While VL has been game changing in airway management, it comes with its own unique challenges. Be careful of the soiled airway, as contamination of the lens can ruin your view quickly. Remember – as discussed above, all VLs are not created equal; if one VL doesn’t work, it may be worth switching up your device or blade. While rare, technology can fail, so make sure to quality check your equipment and have a few backup options immediately available. Remember, VL is not a panacea for all difficult airways. Do an airway assessment. Is awake intubation needed?

Let’s all use common language to discuss VL in the future to better communicate about this technology. More importantly, let’s all become experts with this now ubiquitous technology.

Source
Videolaryngoscopy 2.0. Can J Anaesth. 2021 Dec 16. English. doi: 10.1007/s12630-021-02162-4. Epub ahead of print.

Reviewed by Clay Smith