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A Defining View of the Video Laryngoscope
- Robert M. Knapp (29 February 2008)
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Robert M. Knapp, Anesthesiologist Brigham and Women's Hospital, Boston
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In their recent paper, Cortellazzi et al. demonstrate that a change in laryngoscopy equipment, from the traditional Macintosh to a video laryngoscope, improves the accuracy of an external airway examination.1 I suggest that there is an additional interpretation of their data that may be even more significant. In their study, Cortellazzi et al. attempted almost a thousand intubations using the traditional Macintosh laryngoscope, and a similar number using a video laryngoscope. There were 3 failed intubations in the Macintosh group, and none in the video laryngoscope group. This raises an interesting question: Could the video laryngoscope be a demonstrably more reliable intubating instrument than the traditional laryngoscope? This study, which encompassed nearly 2000 patients, may not provide a definitive answer by itself. Nonetheless, the number of patients studied suggests that the answer may be affirmative. Other authors have reported similar findings. In a case report, Shippey et al. described converting three failed or difficult intubations into easily accomplished ones by substituting a video laryngoscope for a Macintosh.2 In each case, a grade 3 or 4 Cormack and Lehane view was converted to a grade 1 view by the substitution of a video laryngoscope for the traditional one. Shortly after the Corellazzi study, Ndoko et al. reported on a series of 106 morbidly obese patients intubated with either Macintosh or a laryngoscope that functioned on the same around-the-tongue viewing principle as a video laryngoscope.3 Again, all intubations attempted with the alternate laryngoscope were successful, whereas 6 of the Macintosh attempts failed. These failures were then performed successfully with the alternate laryngoscope. In this series, all laryngeal views by the alternate laryngoscope were noted to be Cormack and Lehane grade 1, whereas approximately 20% of the Macintosh views were grade 3 or 4. Although, each study used a different model of alternate laryngoscope, all the instruments shared a common design element. Each one used electronic or optical means to bring the laryngeal view around the tongue to the operator, as opposed to having the operator force a direct line of vision from the mouth to the glottic opening. The significance of this design can be seen in the consistent success of the alternate instruments, as well as by the repeated conversion of difficult laryngeal views to grade 1 views by the simple switch from Macintosh to video (or similarly designed) laryngoscopes. The Cortellazzi study gives a sound reason for considering an expanded role for the video laryngoscope in airway management. It suggests that this type of laryngoscope may have unique capabilities, and shows the way toward future studies to elucidate what they might be. References: 1. Cortellazzi P, Minati L, Falcone C, et al. Predictive value of the El-Ganzouri multivariate risk index for difficult tracheal intubation: a comparison of Glidescopeâ videolaryngoscopy and conventional Macintosh laryngoscopy. Br J Anaesth 2007; 99: 906-11 2. Shippey B, Ray D, McKeown D. Use of the McGrathâ videolaryngoscope in the management of difficult and failed tracheal intubation. Br J Anaesth 2008; 100: 116-119 3. Ndoko SK, Amathieu R, Tual L, et al. Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraqâ laryngoscopes. Br J Anaesth 2008; 100: 263-8 Conflict of Interest:None declared |
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