Role of Video laryngoscopy in the Management of Difficult Airway in Modern Anaesthesiology: A Survey

Sadam  Hussain; Syed Muhammad  Nadeem; Shehrum  Bughio; Hanesh  Tanwani; Yaseen  Ahmed; Fahad  Ali; Nazish  Kanwal

doi:10.54112/bcsrj.v6i2.1574

Authors

Sadam Hussain Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Syed Muhammad Nadeem Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Shehrum Bughio Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Hanesh Tanwani Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Yaseen Ahmed Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Fahad Ali Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan
Nazish Kanwal Department of Anesthesia, Liaquat National Hospital & Medical College, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i2.1574

Keywords:

Video laryngoscope, difficult airway management, Anesthesia practice patterns, Medical device accessibility, Anesthesiologist preferences

Abstract

In patients with anticipated difficult airway, video laryngoscopy (VL) has shown improved laryngeal view, higher success rates, and higher first-attempt success, leading to fewer intubation maneuvers in VL. Objective: To determine the availability, usage factors, restrictions, and preferences of video laryngoscopes in difficult airway management among anesthesiologists in Sindh. Methods: A total of 94 participants were included. A questionnaire was used, which was divided into two parts. The first part contained questions regarding demographic data and difficult airway management. The second part addressed the availability, use, and perception of anesthesiologists toward its use. The data were compiled and analyzed using SPSS version 25. The Shapiro-Wilk test was used to check normality. If the data were non-normal, the median (IQR) was reported. Stratification was performed and post-stratification chi-square or Fisher's exact tests were applied, with a P-value <0.05 considered significant. Results: The mean age of the anesthesiologists was 32.46±5.88 years. The majority (83%, n=78) of participants reported having access to video laryngoscopy. A total of 3 (3.2%) anesthesiologists faced restrictions. The high expense was the reason for not using VLs. First-generation LMA (48.9%), video laryngoscopy (64.9%), and fibreoptic bronchoscopy (42.6%) were the most preferred first, second, and third options for managing the anticipated difficult airways. Conclusion: Most respondents had access to VLs. A very low percentage of participants faced restrictions in using VLs. The high cost of the device is the primary barrier to its use.

Downloads

Download data is not yet available.

References

Nagy B, Rendeki S. A national survey of videolaryngoscopes and alternative intubation devices in Hungary. PLoS One. 2019;14(10):e0223645.

Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017;119(3):369-83.

Rendeki S, Keresztes D, Woth G, Mérei Á, Rozanovic M, Rendeki M, et al. Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airway in mannequins by novices. 2017;17(1):68.

Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81.

Cook TM, Kelly FE. A national survey of videolaryngoscopy in the United Kingdom. Br J Anaesth. 2017;118(4):593-600.

Shruthi AH, Dinakara D, Chandrika YR. Role of videolaryngoscope in the management of difficult airway in adults: A survey. Indian J Anaesth. 2020;64(10):855-62.

Gayathri B, Mani K, Vishak M. Factors Influencing the Time of Intubation Using C-MAC D-Blade® Video Laryngoscope: An Observational Cross-Sectional Study. Cureus. 2023 Jan;15(1):e34050.

Bakshi SG, Singh P, Bhosale S. Role of video-based learning on competency level of direct laryngoscopic skills of novice anaesthesiologists - a randomised clinical trial. Indian J Anaesth. 2022;66:712-8.

Parmekar S, Arnold JL, Anselmo C, Pammi M, Hagan J, Fernandes CJ, et al. Mind the gap: can videolaryngoscopy bridge the competency gap in neonatal endotracheal intubation among pediatric trainees? A randomized controlled study. J Perinatol. 2017;37:979-83

Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth. 2013;60:184-91.

Kılıçaslan A, Topal A, Erol A, Uzun ST. Comparison of the C-MAC D-Blade, conventional C-MAC, and Macintosh laryngoscopes in simulated easy and difficult airway. Turk J Anaesthesiol Reanim. 2014;42:182-9.

Kreutziger J, Hornung S, Harrer C, Urschl W, Doppler R, Voelckel WG, et al. Comparing the McGrath Mac video laryngoscope and direct laryngoscopy for prehospital emergency intubation in air rescue patients: a multicenter, randomized, controlled trial. Crit Care Med. 2019;47:1362-70.

Cook TM, Kelly FE. A national survey of videolaryngoscopy in the United Kingdom. Br J Anesthesia. 2017;118(4):593–600

Gill RL, Jeffrey AS, McNarry AF, Liew GH. The availability of advanced airway equipment and experience with videolaryngoscopy in the UK: two UK surveys. Anesthesiol Res Pract.2015;152014:1–7

Heinrich S, Birkholz T, Irouschek A, Ackermann A, Schmidt J. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia: a single-center analysis of 102,305 cases. J Anesth. 2013;27:815–21

Mathew PJ. Videolaryngoscopy – is there a role in paediatric airway management? Minerva Anestesiol. 2013;79:1326–8

Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014;24:1056–65

Leys C, Toft B. How safe are NHS patients in private hospitals? Learning from the Care Quality Commission. Centre for Health and the Public Interest, 2015. Available from https://chpi.org.uk/wp-content/uploads/2015/12/CHPIPatientSafety-Dec15.pdf

Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anesthesia Database. Anesthesia. 2015;70:272–81

Cook TM, Woodall N, Harp er J, Benger J. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106:632–42

Lu Y, Jiang H, Zhu YS. Airtraq laryngoscope versus conventional Macintosh laryngoscope: a systematic review and meta-analysis. Anesthesia. 2011;66:1160–7

Asai T. Videolaryngoscopes: do they truly have roles in difficult airway? Anesthesiol. 2012;116:515–7

Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anesthesia. 2011;66 Suppl 2:57–64

Kelly FE, Cook TM. Seeing is believing: getting the best out of videolaryngoscopy. Br J Anaesth. 2016;117 Suppl 1:9–13

Kaplan MB, Hagberg CA, Ward DS. Comparison of direct and video-assisted views of the larynx during routine intubation. J Clin Anesth. 2006;18:357–62

Aziz 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. Anesthesiol. 2011;114:34–41

Russell T, Khan S, Elman J, Katznelson R, Cooper RM. Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScopeVR videolaryngoscopy. Anesthesia. 2012;67:626–31

Sakles JC, Mosier J, Patanwala AE, Dicken J. Learning curves for direct laryngoscopy and GlideScopeVR video laryngoscopy in an emergency medicine residency. West J Emerg Med. 2014;15:930–7

Herbstreit F, Fassbender P, Haberl H, Kehren C, Peters J. Learning endotracheal intubation using a novel videolaryngoscope improves intubation skills of medical students. Anesth Analg. 2011;113:586–90

Grundgeiger T, Roewer N, Grundgeiger J, Hurtienne J, Happel O. Body posture during simulated tracheal intubation: GlideScopeVR videolaryngoscopy vs Macintosh direct laryngoscopy for novices and experts. Anesthesia. 2015;70:1375–81

Shruthi AH, Dinakara D, Chandrika YR. Role of videolaryngoscope in the management of difficult airway in adults: A survey. Indian J Anaesth. 2020;64:855-62.

Lewis SR, Butler AR, Parker J, Cook TM, Robinson OJS, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: A Cochrane systematic review. Br J Anaesth. 2017;119:369‑83.

Gordon JK, Bertram VE, Cavallin F, Parotto M, Cooper RM. Direct versus indirect laryngoscopy using a Macintosh video laryngoscope: A mannequin study comparing applied forces. Can J Anaesth. 2020;67:515‑20.

Sakles JC, Mosier J, Patanwala AE, Dicken J. Learning curves for direct laryngoscopy and GlideScope® video laryngoscopy in an emergency medicine residency. West J Emerg Med. 2014;15:930‑7.

Myatra SN, Doctor JR. Use of videolaryngoscopy as a teaching tool for novices performing tracheal intubation results in greater first pass success in neonates and infants. Indian J Anaesth. 2019;63:781‑3.

Saran A, Dave NM, Karnik PP. Efficacy and safety of videolaryngoscopy‑guided verbal feedback to teach neonatal and infant intubation. A prospective randomised cross over study. Indian J Anaesth. 2019;63:791‑6.

Grundgeiger T, Roewer N, Grundgeiger J, Hurtienne J, Happel O. Body posture during simulated tracheal intubation: GlideScope® videolaryngoscopy vs Macintosh direct laryngoscopy for novices and experts. Anesthesia. 2015;70:1375‑81.

Cook TM, Kelly FE. A national survey of videolaryngoscopy in the United Kingdom. Br J Anaesth. 2017;118:593‑600.

Wong DT, Mehta A, Tam AD, Yau B, Wong J. A survey of Canadian anaesthesiologists’ preferences in difficult intubation and “cannot intubate, cannot ventilate” situations. Can J Anaesth. 2014;61:717‑26.

Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway. Anaesthesiol. 2013;118:251–70.

Rajesh MC, Suvarna K, Indu S, Mohammed T, Krishnadas A, Pavithran P. Current practice of difficult airway management: A survey. Indian J Anaesth. 2015;59:801‑6.

Neamat I, Rahman A, Fouad EA, Ahmed A, Taha K. Difficult airway management patterns among anaesthesiologists practicing in Cairo University Hospitals: A survey study. Egypt J Anaesth. 2016;32:67‑75.