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Video laryngoscopy - the past, present and future

Laryngoscopy has come a long way since the advent of the first laryngoscope some 120 years ago. From the initial

direct techniques, laryngoscopy advanced through an era of flexible fibre-optic video laryngoscopes, followed by the more highly developed transition scopes, before the arrival at the end of 2000 of the first commercially available true video laryngoscope – GlideScope® – offering camera-on-blade technology.

The World Airway Management Meeting (WAMM), held on the 14th November 2015 in Dublin, Ireland, saw Verathon host the GlideScope Symposium. Chaired by Dr I Ahmad, Consultant Anesthetist at Guy’s and St Thomas’ NHS Foundation Trust, the event provided the opportunity to learn more about the advent and benefits of the video laryngoscope as Dr J Pacey, the inventor of the GlideScope (Pictured above with Brian Turvey from Cardiogenics), and Dr S Radhakrishna, discussed the history of the technique and the current evidence base for its use. Consultant Anesthetist Dr C Frerk from Northampton General Hospital, who introduced the new DAS intubation guidelines for management of unanticipated difficult intubation in adults at WAMM, was also present to answer questions about the recommendations.

Below see some of the observations from Su et al (4), who evaluated 110 randomized controlled trials comparing direct with video laryngoscopes in both mannequin- and patient-based studies, as well as different video laryngoscopes, posing the questions:

• Is video laryngoscopy better than Macintosh? • Which is quicker to intubate with?

• Which gives the better view?

• Which is better in a difficult airway scenario?

The authors concluded that video laryngoscopes are a good alternative to direct laryngoscopy. It is marginally quicker to intubate with direct laryngoscopy when intubation is easy, although the difference in speed is not significant, but video laryngoscopy is faster when intubation is difficult. The best view is always obtained using a video laryngoscope.

Video laryngoscopes offer a number of advantages:

• An increased viewing angle, from 15 to 60 degrees

• Better image quality

• Can overcome the difficulties of Cormack-Lehane grade 3 and 4 views • Help teaching and research

• Allow documentation of images for clinical review

• Can be used for awake laryngoscopy after anesthetizing the airway

In addition, video scopes can be useful in ENT surgery, helping the insertion of orogastric feeding tubes and biopsies performed in the laryngeal area. They have also been shown to be effective in the intubation of trapped casualties, for example, car accident victims (5).

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