Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice

During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation. In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR. The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option. The aim of this article is to comment the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.

En las últimas dos décadas, el videolaringoscopio (VDL) se ha convertido en una herramienta valiosa y eficaz para el manejo de la vía aérea no solo en el ámbito de anestesiología, sino en otras especialidades médicas durante escenarios clínicos que requieren la intubación traqueal y las cuales, en países como Estados Unidos corresponden anualmente a más de 15 millones dentro de salas de cirugía y 650.000 fuera de ella. Aproximadamente, hay una incidencia global acumulada de 6,8 % de eventos de vía aérea difícil en la práctica rutinaria y 0,1 al 0,3 % de intubaciones fallidas, ambas asociadas a complicaciones como desaturación, daño en la vía aérea, inestabilidad hemodinámica y muerte. Pese a que el VDL ha demostrado ventajas como mejoría de la visualización de la glotis, aumento de tasa de éxito al primer intento y menor curva de aprendizaje, su uso en la mayoría de las veces se ve limitado como dispositivo de rescate o de manera secundaria. El propósito de este artículo es comentar acerca de las ventajas y limitaciones del VDL vs. el laringoscopio directo en un variado número de escenarios clínicos, como salas de cirugía, unidades de cuidado intensivo, emergenciología, pediatría, obstetricia y covid-19, con el fin de considerar si su uso debiera hacerse de manera rutinaria.

Laringoscopia directa vs videolaringoscopia en la intubación del paciente con COVID-19 / Direct laryngoscopy versus videolaryngoscopy in COVID-19 patient intubation

Introducción: Muchos enfermos de COVID-19 requieren ser ventilados. La laringoscopia directa (LD) es el método tradicional empleado en el manejo de la vía aérea; sin embargo, la videolaringoscopia (VL) es una alternativa en estos pacientes. Objetivo: Comparar la laringoscopia directa y la videolaringoscopia en el manejo de la vía aérea en pacientes con COVID-19. Métodos: Se realizó un estudio observacional retrospectivo. El universo y la muestra estuvieron conformado por los pacientes intubados por médicos de la brigada Henry Reeve en hospitales de Cancún y Ciudad de México. Se conformaron dos grupos; el Grupo laringoscopia directa con 91 pacientes y el Grupo videolaringoscopia con 103. Las variables estudiadas fueron: edad, sexo, número de predictores de una vía respiratoria anatómicamente difícil (VRAD), visualización de la apertura glótica, intentos de intubación y las complicaciones de la intubación. El análisis estadístico de los datos se realizó con el paquete estadístico SPSS 23.0. Resultados: Los grupos fueron comparables en cuanto a edad, sexo y predictores de vía respiratoria anatómicamente difícil. La visualización glótica completa o parcial en el grupo videolaringoscopia fue de 97 por ciento, mientras que en el grupo laringoscopia directa fue de 86 por ciento. La intubación endotraqueal al primer intento superó el 70 por ciento en el grupo VL y el 50 por ciento en el grupo LD. Las principales complicaciones encontradas fueron la desaturación y la hipotensión arterial con una mayor frecuencia en el grupo LD (40,7 por ciento y 49,5 por ciento). Conclusiones: La videolaringoscopia mejoró la visualización glótica y la intubación endotraqueal al primer intento, con menos complicaciones en los pacientes estudiados(AU)

Introduction: Many COVID-19 patients require ventilation. Direct laryngoscopy is the traditional method used for airway management; however, videolaryngoscopy is an alternative in these patients. Objective: To compare direct laryngoscopy and videolaryngoscopy for airway management in COVID-19 patients. Methods: A retrospective observational study was carried out. The universe and the sample consisted of patients intubated by physicians from Henry Reeve brigade at hospitals in Cancun and Mexico City. Two groups were formed: the direct laryngoscopy group, with 91 patients, and the videolaryngoscopy group, with 103 patients. The variables studied were age, sex, number of predictors of an anatomically difficult airway, visualization of the glottic opening, intubation attempts, and intubation complications. Statistical analysis of the data was performed using the SPSS 23.0 statistical package. Results: The groups were comparable in terms of age, sex and predictors of an anatomically difficult airway. Complete or partial glottic visualization in the videolaryngoscopy group was 97 percent , while in the direct laryngoscopy group it was 86 percent . Endotracheal intubation at the first attempt exceeded 70 percent in the videolaryngoscopy group and 50 percent in the direct laryngoscopy group. The main complications observed were desaturation and arterial hypotension with a higher frequency in the direct laryngoscopy group (40.7 percent and 49.5 percent , respectively). Conclusions: Video laryngoscopy improved glottic visualization and endotracheal intubation at the first attempt, with fewer complications in the patients studied(AU)

Aplicaciones diagnósticas y terapéuticas del videolaringoscopio C-MAC® en cirugía de vía aérea pediátrica / Diagnostic and therapeutic applications of the C-MAC® videolaryngoscope in pediatric airway surgery

Resumen La patología quirúrgica de la vía aérea pediátrica suele ser desafiante. Una visualización adecuada de las estructuras faríngeas y laríngeas es absolutamente necesaria para su correcto diagnóstico y tratamiento. Distintos instrumentos, como laringoscopios de intubación, laringoscopios de suspensión y broncoscopios flexibles o rígidos, permiten acceder a la vía aérea. Muchas veces se requiere el uso de una combinación de ellos para abordar con éxito estos problemas. En esta revisión, discutimos el uso de videolaringoscopios en el manejo de condiciones como estenosis subglótica, lesiones de vía aérea y cuerpos extraños. Aunque los anestesiólogos los utilizan frecuentemente para intubaciones difíciles debido a su cámara incorporada que facilita la visión de las estructuras laríngeas, existen escasos informes sobre su uso por cirujanos de vía aérea. Las ventajas sobre la laringoscopía convencional incluyen una mejor visualización, la capacidad de supervisar el procedimiento a través de una pantalla, una mejor ergonomía, que es portátil y que permite una rápida inserción de diferentes instrumentos. Consideramos que es particularmente útil en la dilatación de estenosis subglóticas. Presentamos un método fácil, barato y reproducible para realizarla.

Abstract Surgical pediatric airway diseases are often challenging, and an adequate visualization of pharyngeal and laryngeal structures is absolutely necessary for their correct diagnosis and treatment. Different instruments such as intubation laryngoscopes, suspension laryngoscopes and flexible and rigid bronchoscopes allow for access to the airway, and using a combination of them, is usually required to successfully address these problems. In this review, we discuss the use of videolaryngoscopes in the management of conditions such as subglottic stenosis, airway lesions and foreign bodies. Although commonly used by anesthesiologists for difficult intubations because of their built-in cameras that facilitate the view of laryngeal structures, there are scarce reports on its use by airway surgeons. Advantages over standard laryngoscopy include improved visualization and the ability to supervise the procedure through a screen. We also consider that it allows for improved ergonomics, portability and fast insertion of different instruments. We have found it to be particularly useful in subglottic stenosis dilation and an easy, cheap and reproducible method is also presented.

Videolaringoscopia en el abordaje de la vía aérea durante la pandemia de la COVID-19 / Videolaryngoscopy for airway management during the COVID-19 pandemic

Introducción: A finales del año 2019 se reportaron casos de neumonía atípica en Wuhan provocados por un nuevo coronavirus. La intubación endotraqueal puede causar contaminación del personal de salud. Las pautas recientes prefieren la videolaringoscopia porque aumenta las posibilidades de intubación y evita del contacto cercano con el paciente. Objetivos: Describir el abordaje de la vía aérea con videolaringoscopia en pacientes con COVID-19 e identificar las principales complicaciones aparecidas durante la intubación endotraqueal. Métodos: Se realizó un estudio descriptivo, transversal, en el periodo de diciembre de 2020 a febrero de 2021, en el Centro Médico Naval de la Ciudad de México. El universo estuvo conformado por 178 pacientes con COVID-19 que requirieron intubación endotraqueal. Se tomó una muestra de 103 pacientes los cuales fueron atendidos por los médicos cubanos. Resultados: Los pacientes mayores de 60 años representaron el 63,1 por ciento de los casos y el sexo masculino el 65 por ciento El 42,1 por ciento tuvieron un predictor de vía aérea difícil y el 30,1 por ciento, dos o más predictores. Se visualizó completamente la glotis en el 39,8 por ciento de los casos y, parcialmente, en un 57,3 por ciento. La intubación al primer intento se logró en el 73,8 por ciento. Las principales complicaciones encontradas fueron la desaturación (33 por ciento) y la hipotensión arterial (37,9 por ciento). Conclusiones: La videolaringoscopia podría mejorar la visualización de la apertura glótica y la intubación endotraqueal al primer intento. La desaturación y la hipotensión arterial fueron complicaciones que podrían esperarse en los pacientes con la COVID-19 durante este procedimiento(AU)

Introduction: At the end of 2019, cases of atypical pneumonia were reported in Wuhan caused by a new coronavirus. Endotracheal intubation may cause contamination of healthcare personnel. According to recent guidelines, videolaryngoscopy is preferred, because it increases the chances of intubation and avoids close contact with the patient. Objectives: To describe airway management with videolaryngoscopy in patients with COVID-19 and to identify the main complications that appeared during endotracheal intubation. Methods: A descriptive and cross-sectional study was carried out, in the period from December 2020 to February 2021, at the Naval Medical Center in Mexico City. The universe consisted of 178 patients with COVID-19 who required endotracheal intubation. A sample of 103 patients was taken, who were cared for by Cuban doctors. Results: Patients older than 60 years represented 63.1 percent of the cases, while the male sex represented 65 percent. 42.1 percent had one predictor of difficult airway and 30.1 percent had two or more predictors. The glottis was visualized fully in 39.8 percent of cases and partially in 57.3 percent. Intubation on the first attempt was achieved in 73.8 percent. The main complications found were desaturation (33 percent) and arterial hypotension (37.9 percent). Conclusions: Videolaryngoscopy could improve visualization of the glottic opening and endotracheal intubation on the first attempt. Desaturation and hypotension were complications that could be expected in COVID-19 patients during this procedure(AU)

Mobile remote technology in the learning of laryngoscopy in intubation in a training hospital / La tecnología móvil a distancia en el aprendizaje de laringoscopia en la intubación en un hospital de entrenamiento

Abstract: Introduction: Simulation-based training has become a comprehensive practice to improve skill levels in procedures such as intubation. Clinicians performing endotracheal intubation must be competent to perform this technical skill safely. Objective: Determine the success of the use of mobile remote technology in learning intubation laryngoscopy during training in the hospital. Material and methods: Experimental, cross-sectional, comparative, non-blind, randomized study which was made up of 117 students of the Bachelor of Medicine degree at the Autonomous University of Nuevo Leon. Results: Group A with conventional laryngoscopy achieved successful intubation in an average of 106.86 ± 84.87 seconds, group B in 62.90 ± 65.81 and when crossing the groups in the technique, the time of video laryngoscopy was taken, where group A reported an average time of 64.25 ± 34.23, while the time recorded in group B was 84.25 ± 55.67 seconds. Conclusion: The use of mobile remote technology is effective for the preparation of doctors and future doctors when performing an orotracheal intubation. Videolaryngoscopy was significant to conventional laryngoscopy when performed in inexperienced personnel.

Resumen: Introducción: El entrenamiento basado en simulación se ha convertido en una práctica integral para mejorar los niveles de habilidad en procedimientos como la intubación. Los médicos que realizan intubación endotraqueal deben ser competentes. Objetivo: Determinar el éxito del uso de la tecnología remota móvil en el aprendizaje de la laringoscopía de intubación durante la formación en el hospital. Material y métodos: Estudio experimental, transversal, comparativo, no ciego, aleatorizado que contó con 117 estudiantes de la Licenciatura en Medicina de la Universidad Autónoma de Nuevo León. Resultados: El grupo A con laringoscopía convencional logró intubación exitosa en un promedio de 106.86 ± 84.87 segundos, el grupo B en 62.90 ± 65.81 y al cruzar los grupos en la técnica se tomó el tiempo de videolaringoscopía, donde el grupo A reportó un tiempo promedio de 64.25 ± 34.23, mientras que el tiempo registrado en el grupo B fue de 84.25 ± 55.67 segundos. Conclusión: El uso de tecnología remota móvil es efectivo para la preparación de médicos y futuros médicos a la hora de realizar una intubación orotraqueal. La videolaringoscopía fue significativa para la laringoscopía convencional cuando se realizó en personal sin experiencia.

Anestesia en paciente pediátrico con Síndrome de Treacher Collins / Anesthesia in a pediatric patient withTreacher Collins Syndrome / Anestesia em paciente pediátrico com Síndrome de Treacher Collins

El Síndrome de Treacher Collins (STC) constituye un reto para el anestesiólogo por malformaciones craneofaciales que complican el manejo de su vía aérea e intubación. Presentamos el caso de una paciente (8 años) con diagnóstico de STC que debía someterse a una cirugía de colocación de implante de conducción ósea bajo anestesia general. Presentaba un antecedente de intubación difícil, marcada micrognatia y distancia tiromentoniana de 2 cm. Se planteó un esquema de intubación en dos etapas secuenciales. En la primera etapa se realizó una evaluación de la vía aérea (visualización de la glotis) bajo sedación con dexmedetomidina, remifentanilo y propofol. Al visualizar la glotis se pasó a la segunda etapa para realizar la intubación posterior a la inducción anestésica.El manejo exitoso se fundamentó en una sedación adecuada y la utilización de un videolaringoscopio con pala curva para la evaluación previa de la vía aérea y posterior intubación sin complicaciones

Treacher Collins Syndrome (TCS) constitutes a challenge for the anesthesiologist due to craniofacial malformations that make management of the airway and intubation difficult. We present a case of a patient (8-year-old) diagnosed with TCS who had to undergo surgery for the placement of a bone conduction implant under general anesthesia. She had a history of difficult intubation, marked micrognathia and a thyromental distance of 2 cm. An intubation scheme in two sequential stages was proposed. In the first stage, an evaluation of the airway (visualization of the glottis) was carried out under sedation with dexmedetomidine, remifentanil and propofol. When the glottis was visualized, we proceeded to the second stage to carry out intubation after anesthetic induction.The successful management of this case was based on adequate sedation and the use of a video laryngoscope with a curved blade for prior evaluation of the airway and subsequent intubation without complications

A síndrome de Treacher Collins (STC) constitui um desafio para o anestesiologista devido às malformações craniofaciais que dificultam o manejo da via aérea e a intubação. Apresentamos o caso de uma paciente (8 anos) com diagnóstico de STC que foi submetida a uma cirurgia para colocação de implante de condução óssea sob anestesia geral. Ela tinha história de intubação difícil, micrognatia acentuada e distância tiromentoniana de 2 cm. Foi proposto um esquema de intubação em duas etapas sequenciais. Na primeira etapa, foi realizada avaliação das vias aéreas (visualização da glote) sob sedação com dexmedetomidina, remifentanil e propofol. Quando a glote foi visualizada, a segunda etapa foi realizada para realização da intubação após a indução anestésica. O manejo bem-sucedido baseou-se na sedação adequada e no uso de videolaringoscópio com lâmina curva para avaliação prévia da via aérea e posterior intubação sem complicações

Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica / Video laryngoscopy for pediatric intubation, compared to classic orotracheal intubation

Introducción: Un aspecto relevante en anestesia pediátrica es el manejo de la vía aérea. Diferencias anatómicas de esta población, hace que sean más susceptibles a dispositivos diseñados para su manejo. La videolaringoscopía mejora la visión panorámica de la glotis. El objetivo del presente estudio fue comparar el uso de la videolaringoscopía con la laringoscopía directa para intubación orotraqueal, en pacientes pediátricos. Métodos: Con un diseño descriptivo observacional, se estudiaron 276 casos, pacientes de 5 a 17 años, sometidos a cirugía planificada, con anestesia general más intubación orotraqueal. El especialista decidió el dispositivo para manejo. Los datos se transcribieron de los formularios y analizados con el programa SPSS 22.0. El análisis descriptivo se basó en mediana, moda, promedio, valor mínimo, valor máximo. Medidas de dispersión desvío estándar y rango. Se condideró un valor de p < 0.05 como estadísticamente significativo. Resultados: La edad promedio del estudio fue 9.83 años. Con laringoscopía directa 97.4% se realizó la intubación al primer intento y con videolaringoscopía el 88,4% (P=0.003). En el 94.2% de casos de laringoscopía directa se realizó una intubación exitosa en menos de 10 segundos, con videolaringoscopía fue del 75.2% (P<0.001). Complicaciones se presentaron en el 6.6% de intubaciones con videolaringoscopía versus el 2.6% con laringoscopía convencional (P=0.103). El 56.2% de especialistas prefieren laringoscopía directa para manejar una vía aérea pediátrica sin predictores de dificultad. Conclusiones: La videolaringoscopía brinda un apoyo adicional en el manejo de la vía aérea de rutina, amerita siempre conocimientos y destrezas previas. La evidencia para avalar una técnica por sobre otra es insuficiente

Introduction:A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value,maximum value. Standard deviation and range dispersion measurements. A value pf p < 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient

Videolaringoscopía para intubación pediátrica, en comparación con la intubación orotraqueal clásica. Hospital Vicente Corral Moscoso, Cuenca, 2018 / Video laryngoscopy for pediatric intubation, compared to classical orotracheal intubation. Vicente Corral Moscoso Hospital, Cuenca, 2018

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Introduction: A relevant aspect in pediatric anesthesia is the management of the airway. Anatomical differences in this population makes them more susceptible to devices designed for their management. Video laryngoscopy improves panoramic vision of the glottis. Objective: To compare the use of video laryngoscopy with direct laryngoscopy for orotracheal intubation in pediatric patients. Methods: With an observational descriptive design, 276 cases were studied, patients from 5 to 17 years old, undergoing planned surgery, with general anesthesia plus orotracheal intubation. The specialist decided on the handling device. The data was transcribed from the forms and analyzed with the SPSS 22.0 program. The descriptive analysis was based on median, mode, average, minimum value, maximum value. Standard deviation and range dispersion measurements. A value of p ≤ 0.05 was considered statistically significant. Results: The average age of the study was 9.83 years. With direct laryngoscopy 97.4% intubation was performed at the first attempt and with video laryngoscopy 88.4% (p = 0.003). In 94.2% of cases of direct laryngoscopy, a successful intubation was performed in less than 10 seconds, with video laryngoscopy it was 75.2% (p = 0.000). Complications occurred in 6.6% of intubations with video laryngoscopy versus 2.6% with conventional laryngoscopy (p = 0.103). 56.2% of specialists prefer direct laryngoscopy to manage a pediatric airway without predictors of difficulty. Conclusions: Video laryngoscopy provides additional support in routine airway management, always requiring prior knowledge and skills. The evidence to support one technique over another is insufficient.

Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial / Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

Abstract Background and objectives We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. Methods A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. Results and conclusions First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p > 0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4 s, p < 0.001), and time to intubation (95% CI 3-4.6 s, p < 0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4 s, p < 0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p < 0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Resumo Justificativa e objetivos Comparamos a eficiência do videolaringoscópio King Vision e do laringoscópio Macintosh, quando usados por anestesiologistas experientes em pacientes adultos com diferentes condições de intubação, em um estudo clínico prospectivo randomizado e controlado. Métodos Foram selecionados 388 pacientes com estado físico ASA I ou II (de acordo com a classificação da American Society of Anesthesiologists - ASA), programados para anestesia geral com intubação traqueal. Cada paciente foi intubado com ambos os laringoscópios sucessivamente, em uma ordem aleatória. A taxa de sucesso da intubação, o tempo até a melhor visibilização da glote, o tempo de intubação, o tempo de ventilação, a classificação de Cormack-Lehane (graus) e as complicações relacionadas à laringoscopia e intubação foram analisados. Resultados e conclusões As taxas de sucesso na intubação na primeira tentativa foram similares para o King Vision e o Macintosh (96,6% vs. 94,3%, respectivamente, p > 0,05). As médias dos tempos até a melhor visibilização da glote (IC 95% 0,5-1,4 s, p < 0,001) e de intubação (IC 95% 3-4,6 s, p < 0,001) foram maiores no King Vision. A diferença no tempo de intubação foi semelhante quando as tentativas malsucedidas de intubação foram excluídas (IC 95% 2,8-4,4 s, p < 0,001). Com base na classificação de Mallampati modificada na consulta pré-operatória, o King Vision melhorou significativamente a visibilização da glote em mais pacientes (220 pacientes, 56,7%) em comparação com o Macintosh (180 pacientes, 46,4%) (p < 0,001). Nenhum dos pacientes apresentou dessaturação periférica de oxigênio abaixo de 94%. Os anestesiologistas experientes podem obter taxas semelhantes de sucesso na primeira tentativa de intubação e de traumas das vias aéreas com ambos os laringoscópios. O King Vision requer tempos mais longos até a visibilização da glote e de intubação traqueal, mas não causa dessaturação adicional.

Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy. / Evaluación del videolaringoscopio Airtraq como dispositivo de rescate tras laringoscopia directa difícil.

BACKGROUND AND OBJECTIVES: Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. METHODS: 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. RESULTS: The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. CONCLUSIONS: Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.

[Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial]. / Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado.

BACKGROUND AND OBJECTIVES: We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. METHODS: A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. RESULTS AND CONCLUSIONS: First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p>0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4s, p<0.001), and time to intubation (95% CI 3-4.6s, p<0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4s, p<0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p<0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Videolaringoscopios: ¿la solución para el manejo de la vía aérea difícil o una estrategia más? Revisión no sistemática / Videolaryngoscopes: The solution for difficult airway management or just another strategy? Non-systematic review

Introduction: Difficult airway management remains a challenge and is a pillar of anesthesia training. At present, unsuccessful management of the difficult airway is a leading cause of complications in the practice of anesthesia, something that has led to regular updates to the management algorithms and the development of new technologies. Objectives: To review the current state of videolaryngoscopy and its impact on difficult airway management. Methods: With the keywords Videotape Recording; Laryngoscopy; Airway Management; Intubation; Intratracheal; Obesity; Anesthesia. A non-systematic review in the following databases was conducted: Pubmed/Medline, SciElo, LILACS). Results: Videolaryngoscopes are a new technology for the management of difficult airways that so far have not replaced the standard airway management algorithm devices. Its main impact is better visualization of the laryngeal structures. However, there are still controversies regarding the ease and success of tracheal intubation. Evidence of its usefulness in difficult airway management is weak. Conclusion: Knowledge of these devices and their limitations is an alternative in difficult airway scenario, but its real value and safety for the patient is still not defined and continues to be researched.

Introducción: el manejo de la vía área difícil continua siendo un reto y es uno de los pilares del entrenamiento en anestesia. En la actualidad, el manejo no exitoso de la vía aérea difícil representa una de las principales causas de complicación en el ejercicio de la anestesia que promueve la actualización regular de los algoritmos de manejo y al desarrollo de nuevas tecnologías. Objetivos: presentar el estado actual de los videolaringoscopios y su impacto en el manejo de la vía aérea. Métodos: con las palabras claves: Grabación en video Laringoscopia, Intubación intratraqueal; Vía aérea difícil; Obesidad; Anestesia; Emergencias se realizó una revisión no sistemática en bases de datos (PubMed/Medline, SciElo, Lilacs). Resultados: los videolaringoscopios son una tecnología adicional para el manejo de la vía aérea que hasta el momento no han demostrado sustituir los dispositivos estándares expuestos en el algoritmo de manejo de la vía aérea. Su principal impacto está determinado por la mejoría en la visualización de las estructuras de la laringe sin embargo aún hay controversias respecto a la facilidad y éxito de la intubación endotraqueal. La evidencia de su utilidad en el manejo exitoso de la vía aérea difícil es débil. Conclusiones: el conocimiento de estos dispositivos así como sus limitaciones constituye una alternativa en el escenario de la vía aérea difícil, pero su valor real y la seguridad que representa para el paciente aún no se han definido y continúa en investigación.

Video laringoscopio Glidescope y la laringoscopia Machintosh para la intubación en el Hospital Nacional Daniel Alcides Carrión 2014 / Glidescope videolaryngoscope and Macintosh laryngoscopy for the intubation at the National Hospital Daniel Alcides Carrion 2014

Objetivo: Describir las características asociadas al uso de la videolaringoscopía Glidescope y la laringoscopía Machintosh como sistema de control de la vía aérea, en pacientes sometidos a anestesia general en la institución. Método: Analizamos 75 pacientes sometidos a anestesia general e intubación endotraqueal a quienes se les evaluó y en algunos casos se determinaron predictores de vía aérea difícil. Se utilizó laringoscopía directa Machintosh y videolaringoscopía Glidescope como dispositivos de intubación. Se valoró la dificultad de la técnica empleada, tiempo de intubación y número de intentos. Se reportaron los cambios en la pulsioximetría previa y posterior a la intubación. En la visita posterior a los pacientes se verificó la presencia de odinofagía, tos, sangrado, náuseas entre otros. Resultados: Independientemente de los predictores de vía aérea difícil se catalogó como técnica dificultosa al 57.9 por ciento de procedimientos con videolaringoscopía y con laringoscopía directa al 37.8 por ciento de los casos. En los pacientes con predictores de vía aérea difícil el uso de la videolaringoscopía fue más efectivo que la laringoscopía directa. El 100 por ciento de los casos fueron intubables, sin embargo se necesitaron hasta 3 intentos con el uso de laringoscopía directa (8.3 por ciento de los casos). No hubo diferencia significativa en el tiempo de intubación, saturación de oxígeno previa y posterior al procedimiento. La odinofagía y las náuseas fueron los síntomas mayormente referidos en el post operatorio. Conclusiones: La totalidad de los casos fueron exitosos con el uso de los dos dispositivos, sin embargo la videolaringoscopía ofreció menor dificultad al tratarse de aquellos pacientes con predictores de vía aérea difícil. El personal debe entrenarse en el uso de nuevos dispositivos para abordar casos de vía aérea difícil.

Objective: To describe the characteristics associated with use of the Glidescope videolaryngoscope and Machintosh laryngoscopy as a control system of the airway in patients undergoing general anesthesia in the institution. Method: We analyzed 75 patients undergoing general anesthesia and endotracheal intubation who were evaluated and in some cases of difficult airway predictors were determined. Direct laryngoscopy Machintosh and videolaryngoscope Glidescope as intubation devices used. The difficulty of the technique used, intubation time and number of trials was assessed. Changes were reported in pre-and post-intubation pulse oximetry. In the subsequent visit patients the presence of sore throat, cough, bleeding, nausea among others verified. Results: Regardless of the predictors of difficult airway was classified as difficult to 57.9 per cent of procedures videolaryngoscope and direct laryngoscopy to 37.8 per cent of cases technique. In patients with difficult airway predictors using the videolaryngoscope was more effective than direct laryngoscopy. 100 per cent of the cases were intubables, however it took up to 3 attempts using direct laryngoscopy (8.3 per cent of cases). There was no significant difference in intubation time, oxygen saturation pre and post procedure. The sore throat and nausea symptoms were mostly reported in the postoperative period. Conclusions: All the cases were successful with the use of two devices, however videolaryngoscope offered less difficult y when dealing with patients with difficult airway predictors. Staff should be trained in the use of new devices to address cases of difficult airway.