Outline the advantages and disadvantages of videolaryngoscopy as compared to direct laryngoscopy.
Videolaryngoscopy (VL) utilizes video camera technology to visualize airway structures and facilitate endotracheal intubation. It could allow good exposure of the glottis without the need to align oral, pharyngeal and tracheal axes.
• Improve laryngeal view and glottic visualization
a. Improve laryngeal view: allow assessment of larynx, facilitate procedures, e.g. NG Tube placement, ETT exchange
b. reduce failed intubations
• VL requires the application of less force to the base of the tongue, therefore is less likely to induce local tissue injury.
• Allows less cervical spine movement for intubation compared with direct laryngoscopy
• Allows others to view the screen
a. Allow assistant to help facilitate endotracheal intubations, e.g. enable real time cricoid force optimization, optimal external laryngeal manipulation to improve view
b. Facilitate teaching and supervision of endotracheal intubation
• Can allow video recording to provide an official record of tracheal intubation
• Faster learning curve than direct laryngoscopy
• Possible difficulty in passing endotracheal tube despite improved glottic visualization especially with hyper angulated ‘D’ blade, termed “laryngoscopy paradox”. Use of a bougie or stylet would be recommended. Hyper angulated blades may prolong easy intubations.
• Multiple devices exist with unique learning curves. Training is required
• Blood, secretions and vomitus in the airway as well as fogging can hamper use of VL
• Potential for false sense of security and lack of preparation for difficult airway. VLs are not the panacea for difficult airway management. All airway plans that utilize VL require a plan for technical failure.
• VL are more expensive. Additional maintenance and disinfection arrangement.
• Potential weakening in development and maintenance of direct laryngoscopy skill set
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AnaesthesiaUK have a nice page about McCoy blades.
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