Izazovi u uporabi video laringoskopa

Abstract

Despite the lack of uniformity and the need of further investigation, video laryngoscopy continues to gain popularity both inside and outside the operating room. It has quickly become a first line strategy for potential and/or encountered difficult intubation. It is well established that video laryngoscope improves laryngeal view as compared with direct laryngoscopy in patients with suspected difficult intubation and simulated difficult airway scenarios. For novices and experienced anesthesiologists alike, video laryngoscopy is easy to use and the skills involved are easy to master. However, it is important to say that video laryngoscopes may be used in a variety of clinical scenarios and settings because of the video laryngoscope design offering an alternative intubation technique in both anaesthetized and awake patients. The aim of this article is to show and highlight clinical situations in which the use of video laryngoscope is a challenge for an experienced anesthesiologist in solving the airway. Challenges in the use of video laryngoscope with which we deal and encounter in everyday clinical practice that are discussed in this paper are intubation in the prehospital setting and emergency departments, intubation in Intensive Care Unit, intubation in a patient with cervical spine immobilization, and awake video laryngoscopy-assisted tracheal intubation in the obese. We also point out the important role of video laryngoscope as a tool for teaching and training in airway education. Training and education in difficult airway management is essential to improve patient safety at endotracheal intubation in emergency situation.Unatoč nedostatku ujednačenosti proizvoda na tržištu i potrebe za daljnjim istraživanjem, video laringoskopi i dalje su popularni unutar i izvan operacijske dvorane. Oni su postali prva linija u strategiji za potencijalne i/ili teške intubacije. Dobro je poznato da video laringoskopi poboljšavaju prikaz larinksa u usporedbi s direktnom laringoskopijom u bolesnika sa sumnjom na otežanu intubaciju i kod simuliranih teških pristupa dišnome putu. Za početnike i iskusne anesteziologe podjednako video laringoskop je jednostavan za korištenje, a vještine koje su potrebne za rad s njim su lako savladive. Osobitost video laringoskopa je da se može koristiti u različitim kliničkim situacijama s obzirom na to da su osmišljeni tako da nude alternativnu tehniku i u anesteziranih i kod budnih bolesnika. U ovom radu želimo ukazati na kliničke situacije u kojima korištenje video laringoskopa predstavlja izazov za iskusne anesteziologe u rješavanju otežanoga pristupa dišnome putu. Specifične indikacije za korištenje video laringoskopa u svakodnevnoj kliničkoj praksi su: intubacija u pre-hospitalnim uvjetima i hitnim odijelima; intubacija u jedinici intenzivnog liječenja; intubacija bolesnika s imobiliziranom vratnom kralježnicom te budna intubacija u pretilih bolesnika. U radu također ističemo važnu ulogu laringoskopa u edukaciji prikaza i tehničkog savladavanja pristupa dišnome putu. Obuka i obrazovanje u zbrinjavanju otežanoga dišnog puta je nužna radi poboljšanja sigurnosti bolesnika u hitnim stanjima kod kojih je neophodna uspostava dišnoga puta