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• W1857996910 abstract "Editor—The editorial article by Zaouter and colleagues1Zaouter C Calderon J Hemmerling TM Videolaryngoscopy as a new standard of care.Br J Anaesth. 2014; 114: 181-183Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar recommending videolaryngoscopy as a new standard of care was of great interest. Videolaryngoscopes are indeed promising intubation devices because they provide an improved laryngeal view. However, we do not agree with the authors that videolarygnoscopes should replace direct laryngoscopes and be used for all intubations in current practice. The quantitative review and meta-analysis regarding the performance of video- and direct laryngoscopes indicate that in patients with a normal airway, the success rate of intubation with videolarygnoscopes is approximately the same as with direct laryngoscopes, but the intubation time is significantly prolonged with videolaryngoscopes;2Niforopoulou P Pantazopoulos I Demestiha T Koudouna E Xanthos T Video-laryngoscopes in the adult airway management: a topical review of the literature.Acta Anaesthesiol Scand. 2010; 54: 1050-1061Crossref PubMed Scopus (239) Google Scholar, 3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar, 4Sun Y Lu Y Huang Y Jiang H Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials.Paediatr Anaesth. 2014; 24: 1056-1065Crossref PubMed Scopus (123) Google Scholar, 5Hoshijima H Kuratani N Hirabayashi Y Takeuchi R Shiga T Masaki E Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis.Anaesthesia. 2014; 69: 911-918Crossref PubMed Scopus (37) Google Scholar, 6Agro' FE Doyle DJ Vennari M Use of GlideScope® in adults: an overview.Minerva Anestesiol. 2015; 81: 342-351PubMed Google Scholar that is, tracheal intubation in patients with a normal airway can be achieved quickly and in a cost-efficient manner with direct laryngoscopes. In fact, the most convincing literature to date supports the use of videolaryngoscopes only in unanticipated, difficult, or failed intubations with direct laryngoscopy.2Niforopoulou P Pantazopoulos I Demestiha T Koudouna E Xanthos T Video-laryngoscopes in the adult airway management: a topical review of the literature.Acta Anaesthesiol Scand. 2010; 54: 1050-1061Crossref PubMed Scopus (239) Google Scholar, 3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar, 6Agro' FE Doyle DJ Vennari M Use of GlideScope® in adults: an overview.Minerva Anestesiol. 2015; 81: 342-351PubMed Google Scholar The available evidence also shows that videolaryngoscopes are associated with better intubation success and faster intubation time only for inexperienced operators, but they provide no benefit in either of these outcomes with experienced operators.3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar, 6Agro' FE Doyle DJ Vennari M Use of GlideScope® in adults: an overview.Minerva Anestesiol. 2015; 81: 342-351PubMed Google Scholar Thus, we argue that videolaryngoscopes are not the best care for all patients and the direct laryngoscope is not an outdated intubation device, especially for providers able to complete substantial training in controlled circumstances, such as experienced anaesthetists, who are often called as airway experts. Furthermore, there are several different types of videolaryngoscopes available, each with a different blade shape, user interface and geometry, and tube insertion strategy.2Niforopoulou P Pantazopoulos I Demestiha T Koudouna E Xanthos T Video-laryngoscopes in the adult airway management: a topical review of the literature.Acta Anaesthesiol Scand. 2010; 54: 1050-1061Crossref PubMed Scopus (239) Google Scholar, 3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar So far, there is inconclusive evidence to indicate which videolaryngoscope design could be more advantageous in various clinical situations. Thus, the open questions remain. Which videolaryngoscope is the most cost-effective device for routine or difficult intubation? Which one is the optimum to become a new standard of care? Given that device-specific proficiency is critical for successful use of any intubation device, if videolaryngoscopes are used as routine intubation devices, do anesthesiologists need to learn and achieve clinical competence for all devices? Perhaps, there might be a need to revise the current airway training programmes because they do not include videolaryngoscopic intubation training in the minimal skill set acquired by a trainee during an airway rotation.7Baker PA Weller JM Greenland KB Riley RH Merry AF Education in airway management.Anaesthesia. 2011; 66: S101-S111Crossref PubMed Scopus (50) Google Scholar In addition, most of current difficult airway algorithms are developed as rescue guides in the event of difficult or failed direct laryngoscopy, and these algorithms rely on videolaryngoscopes as rescue tools for difficult or failed direct laryngoscopy.8American Society of Anesthesiologists Task Force on Management of the Difficult Airway Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.Anesthesiology. 2013; 118: 251-270Crossref PubMed Scopus (1430) Google Scholar, 9Japanese Society of Anesthesiologists JSA airway management guideline 2014: to improve the safety of induction of anesthesia.J Anesth. 2014; 28: 482-493Crossref PubMed Scopus (109) Google Scholar, 10Neyrinck A Management of the anticipated and unanticipated difficult airway in anesthesia outside the operating room.Curr Opin Anaesthesiol. 2013; 26: 481-488PubMed Google Scholar Although use of videolaryngoscopes is rapidly growing in clinical practice, there is still no evidence-based airway algorithm where tracheal intubation relies mainly on videolaryngoscopy. If videolaryngoscopes are used as the routine first-line intubation devices, one pertinent question is, what should one do in the event of a difficult or failed videolaryngoscopy? It must be emphasized that despite the very good visualization of the glottis, videolaryngoscopy does not give a 100% success rate.2Niforopoulou P Pantazopoulos I Demestiha T Koudouna E Xanthos T Video-laryngoscopes in the adult airway management: a topical review of the literature.Acta Anaesthesiol Scand. 2010; 54: 1050-1061Crossref PubMed Scopus (239) Google Scholar, 3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar, 6Agro' FE Doyle DJ Vennari M Use of GlideScope® in adults: an overview.Minerva Anestesiol. 2015; 81: 342-351PubMed Google Scholar In a two-centre study, the GlideScope videolaryngoscope failed once every 33 patients with a difficult airway and once every 16 patients with failed direct laryngoscopy.11Aziz MF Healy D Kheterpal S Fu RF Dillman D Brambrink AM Routine clinical practice effectiveness of the GlideScope in difficult airway management: an analysis of 2,004 GlideScope intubations, complications, and failures from two institutions.Anesthesiology. 2011; 114: 34-41Crossref PubMed Scopus (304) Google Scholar Thus, if videolaryngoscopes are part of a new airway management protocol in which they are routinely used as first-line intubation devices, there would be a need to reconsider airway management algorithms and adopt a strategy to manage failures.3Griesdale DEG Liu D McKinney J Choi PT Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis.Can J Anaesth. 2012; 59: 41-52Crossref PubMed Scopus (252) Google Scholar, 12Rothfield KP Russo SG Videolaryngoscopy: should it replace direct laryngoscopy? a pro-con debate.J Clin Anesth. 2012; 24: 593-597Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Finally, Zaouter and colleagues1Zaouter C Calderon J Hemmerling TM Videolaryngoscopy as a new standard of care.Br J Anaesth. 2014; 114: 181-183Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar advise integration of videos obtained during videolaryngoscopic intubation into an anaesthesia information management system. To the best of our knowledge, most videolaryngoscopes used in current practice have no such function to transmit moment-by-moment videos into an anaesthesia information management system, and some of them even have no functional design for recording and saving intubation pictures. Perhaps, the manufacturers of videolaryngoscopes should be encouraged to provide such electronic additions to their products in order to integrate imaging of the patient’s tracheal intubation into anaesthesia electronic charting. We believe that with further developments and refinements in technology, this may no longer be an issue. None declared." @default.
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