Videolaryngoscopy for Difficult Airway Management in the Operating Room

Abstract

Introduction: Videolaryngoscopy has been widely adopted for difficult airways, but its advantage over direct laryngoscopy in unselected patients is debated. This review compares videolaryngoscopy versus direct laryngoscopy for first-attempt intubation success in patients with predictors of difficult airway.

Methods: Literature review identified randomized trials comparing videolaryngoscopy (any device with a camera on the blade) versus direct laryngoscopy in adults with at least one difficult airway predictor (Mallampati class III or IV, limited neck mobility, mouth opening <3 cm, or thyromental distance <6 cm). Primary outcome was first-attempt success rate. Secondary outcomes included time to intubation and dental trauma.

Results: Twelve trials (1,896 patients) were included. Videolaryngoscopy improved first-attempt success from 78% to 92% (relative risk 1.18). Time to intubation was longer by 15 seconds with videolaryngoscopy in experienced users but shorter by 10 seconds in trainees. Dental trauma incidence decreased from 8% to 2% with videolaryngoscopy. No difference in hypoxemia events was observed.

Discussion: Videolaryngoscopy provides an indirect view of the glottis, reducing the need for head positioning and allowing the operator to look at a screen rather than into the mouth. The longer intubation time in experienced users reflects the learning curve and equipment preparation. Device type (hyperangulated vs standard geometry blade) influenced outcomes.

Conclusions: Videolaryngoscopy improves first-attempt success for difficult airways and reduces dental trauma. It should be available for all cases with predicted difficulty.