Archive May 2014 XV, No. 5

Assessing Your Airway Visualization Options

3 factors that matter most to the anesthesia providers who depend on the technology.

David Bernard, Senior Associate Editor


video-assisted laryngoscopy GUIDING VIEW Video-assisted laryngoscopy lets you navigate difficult airway anatomy.

Video-equipped laryngoscopes were originally designed to help resolve emergency airway situations, but have gained widespread and routine use for intubating even less-than-difficult anatomies. To the anesthesia providers who swear by them, the following considerations can make a big difference when airway management demands a closer view.

1. Ease of use
The video laryngoscope has become the preferred alternative to traditional direct laryngoscopy for emergency endotracheal intubation. It's a choice that providers facing airway difficulties can put into immediate action. The key to its use, then, is ease of use. "Is it straightforward in terms of hooking it up, turning it on and using it in clinical situations?" asks CRNA Jeff Cryder, BS, BSN, MSA. He and his colleagues at Scott & White Hospital in Temple, Texas, have trialed a range of video laryngoscopes on the market, observing also how they fit each patient.

Some devices conveniently approximate how the blade is inserted into the mouth, so it's easier to maneuver and align with the glottic opening, in comparison with a fiber-optic scope or intubating LMA, says Mr. Cryder, adding that others are difficult to get into the mouths of patients with short necks, large breasts or halo traction. A device that offers an assortment of blades — different sizes, types and degrees of curve — will be more adaptable to more anatomical situations, whether that means adults, obese adults or children.

While many video laryngoscopes have a shallow learning curve, don't take the increased safety they deliver for granted. "Make sure everyone managing airways is trained and checked off on the device, so they will know the right way and wrong way to use it," says Mr. Cryder.

In fact, the need for training is a compelling argument for routinely using video laryngoscopes in uncomplicated cases. You can't expect a rapid-response backup plan to succeed if it hasn't been thoroughly practiced.

"The single most important thing is to use these devices to get good," says D. John Doyle, MD, PhD, a professor of anesthesia at the Cleveland Clinic in Ohio. "If you only use them for emergencies, you're not going to be very slick with them." Use them in normal anatomy to develop and maintain competency, he suggests. Practice makes the purchase pay off.

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