Fonck, Kristine

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Ghent University Academic Bibliography

© Acta Anæsthesiologica Belgica, 2008, 59, n° 3Abstract : Video-assisted laryngoscopy is a rather newtechnique that has been developed for visualisation of theglottis in those cases where conventional laryngoscopyis insufficient to obtain that goal. Moreover, it can be auseful tool for teaching purposes (1). Without any doubt,video-assisted laryngoscopy is a very useful tool for themodern anaesthesiologist. However, comparison of thedifferent available devices is problematical, because theyall have some advantages and disadvantages.We tried out the clinical use of four commercially available devices, the Laryflex (M.E.C.-Accutronic), theMcGrath Video Laryngoscope (Surgical Company), theGlide Scope (Verathon Medical) and the Airtraq (Prodol– Teleflex) (2, 3, 4, 5). For the trained user, all deviceswere very user-friendly. However, some minor short -comings need to be mentioned. In cases of emergency difficult intubation, portability ofthe intubating device is a major item. We observed thatsome of the studied devices were rather cumbersome tohandle and to install. But of course, this problembecomes insignificant with the growing experience of theuser.Another problem is that you need a certain degree ofmouth opening, at least 15 mm. Therefore, in cases ofdiminished mouth opening, the system cannot fullyreplace fiberoptic bronchoscopic intubation.During the procedure of ‘trying to intubate’, the studieddevices were equivalent with other devices used for dif-ficult intubation e.g. Fastrach,... . However, when using avideolaryngoscope, oxygenation is not possible duringthe period of intubation.Videolaryngoscopy is an indirect technique. This hasfor consequence that fogging, saliva, debris and bloodmay blur the vision during endoscopy (6). Optimal lightconditions are also necessary because bright sunlightdegrades the image quality of liquid crystal displays(LCD’S).Most of the time, visualisation of the glottis is bettercompared with direct laryngoscopy, but an improvedview does not mean an improved ease of intubation.However, once the user gets familiar with this new tech-nique, the manipulation of instruments under indirectvision becomes very straightforward. Almost all video-laryngoscopes need the use of a stylet, which means thatthe risk for tracheal damage can be increased (7, 8).Economical aspects have to be considered. More sophis-ticated techniques produce a higher risk of damage andthe necessary reparation. This also means that during theperiod of reparation, the instruments are not available,unless we purchase more than one device. This may pro-duce more costs. The unmistakable benefits of video-assisted laryngoscopy need to be weighted against theseeconomical aspects. Key words : Anaesthesia ; difficult intubation ; videoassisted laryngoscope.References1. Low D., Healy D., Rashburn N.,The use of the BERCI DCIVideo Laryngoscope for teaching novices direct laryn-goscopy and tracheal intubation, ANAESTHESIA, 63, 195-201,2008.2. Kaplan M. B., Hagberg C. A., Ward D. S., Branbrink A.,Chhibber A. K., Heidegger T., Lozada L., Ovassapian A.,Parsons D., Ramsay J., Wilhelm W., Zwissler B., Gerig H. J.,Hofstetter C., Karan S., Kreisler N., Pousman R. M.,Thierbach A., Wrobel M, Berci G., Comparison of directand video-assisted views of the larynx during routine intuba-tion, J. CLIN. ANESTH., 18, 357-362,2006.3. Lai H. Y., Chen I. H., Hwang F. Y., Lee Y., The use of theGlideScope for tracheal intubation in patients with ankylos-ing spondylitis. BRIT. J. ANAESTH., 97, 419-422, 2006.4. Benjamin F. J., Boon D., French R. A., An evaluation of theGlideScope, a new video laryngoscope for difficult airways :a manikin study, EUR. J. ANAESTH., 23, 517-521, 2006.5. Maharaj C. H., Costello F. J., Harte B. H., Laffey J. G.,Evaluation of the Airtraq and Macintosh Laryngoscopes inpatients at increased risk for difficult tracheal intubation,ANAESTHESIA, 63, 182-188, 2008.6. Van Zundert A., Stessel B., De Ruiter F. Giebelen D.,Weber E., Video-assisted Laryngoscopy a useful adjunct inendotracheal intubation, ACTA ANAESTHESIOL. BELG., 58,129-131, 2007.7. Chen E. H., Logman Z. M., Glass P. S. A., Bilfinger T. V.,A case of tracheal injury after emergent endotracheal intubation : a review of the literature and causalities,ANESTH. ANALG., 93, 1270-1271, 2001.8. Kaloud H., Smolle-Juettner F., List W. F., Iatrogenic rup-tures of the tracheobronchial tree, CHEST, 112, 774-778,1997.(Acta Anaesth. Belg., 2008, 59, 175)Video-assisted laryngoscopy :  useful tool with some growing painsK. FONCKKristine FONCK, M.D.Correspondence address : Kristine Fonck, Ghent UniversityHospital, De Pintelaan 185, 9000 Gent, Belgium. Tel. :++32 332 5615. E-mail : Kristine.Fonck@Ugent.be

Video-assisted laryngoscopy: useful tool with some growing pains

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Video-assisted laryngoscopy: useful tool with some growing pains

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