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Abstarct: Background: The optimal positioned double-lumen endotracheal tubes (DLT) is crucial in thoracic surgery requiring lung isolation. This study aims to compare the accuracy and complication rates of DLT placement using videolaryngoscopy (VL) versus conventional direct laryngoscopy (DL). Methods: This retrospective single-center study included 89 patients who underwent thoracic surgery with DLT placement between July 2023 and May 2024. Patients were divided into two groups: VL (n = 45) and DL (n = 44). Patient characteristics, intubation times, malposition rates, and complications were recorded. DLT position was confirmed using fiberoptic bronchoscopy. Results: The incidence of DLT malposition was significantly lower in the VL group (13.3%) compared to the DL group (31.8%) (p = 0.037). The overall complication rate was also lower in the VL group (4.4%) compared to the DL group (11.4%) (p = 0.024). The mean time from anesthesia induction to the first incision was shorter in the VL group (25.2 ± 6.1 min) than in the DL group (28.3 ± 6.5 min) (p = 0.02). Conclusions: VL significantly reduces the incidence of DLT malposition and associated complications in thoracic surgery compared to DL. The improved visualization and multiple blade options of the C-MAC videolaryngoscopy set likely contribute to these findings. Further research is warranted to confirm these results in larger, multicenter studies. Trial registration: Institutional Review Board (Registration number: 80576354-050-99/437, 27.06.2024). [ABSTRACT FROM AUTHOR]

Deaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon dioxide) or as a two-step process (adding identification of the tracheal tube passing through the vocal cords during videolaryngoscopy). In two hospitals we introduced two-person checking of tracheal intubation. In one hospital this involved the one-step process and in the other the two-step process. We used anonymous online questionnaires before, during, and after these changes to collect opinions from anaesthetists and their assistants regarding the feasibility and acceptability of these changes. Most intubators (116/149, 78%) and intubators' assistants (70/72, 97%) reported that the two-person verbal intubation check would reduce the likelihood of unrecognised oesophageal intubation. Benefits and lack of negative aspects were reported for both one-step and two-step two-person intubation checks in both centres. Intubators judged that the checks improved communication and teamwork (118/149, 79%); intubators' assistants reported feeling more empowered to voice concerns if needed (69/72, 96%), a flattened team hierarchy (53/72, 74%), and feeling more valued as team members (64/72, 89%). Most intubators (122/149, 82%) and intubators' assistants (68/72, 94%) planned to continue using the two-person intubation check for all future intubations. Our results suggest that a two-person verbal intubation check is feasible and acceptable to all members of the intubating team. [ABSTRACT FROM AUTHOR]

The assessment of early laryngeal cancer and pre-neoplastic lesions is subjective and depends on doctors' experience, leading to missed diagnoses in primary institutions. Our objective was to develop and validate a deep learning algorithm for the real-time identification of early laryngeal cancer and pre-neoplastic lesions, aiming to enhance diagnostic accuracy. The challenge observed in the domain of deep learning arises from overlooking contextual information. In response, we introduce in this paper a learning methodology that advances from acknowledging the surrounding context to integrating it, providing a resolution to this problem. Initially, we introduce side-aware features to capture relevant characteristics. Subsequently, we employ a rectangular selection technique for accurately determining regions of interest. To assess the effectiveness of our approach in object detection, we perform evaluations on a clinical dataset. Our deep learning approach exhibits robust performance in discriminating cancer. The images were randomly divided into training (80%), testing (10%), and validation (10%) sets. The testing was performed on a laryngoscope dataset consisting of 1123 samples. When compared with other advanced detection models, our methodology surpassed them, demonstrating superior results in laryngoscope detection, including mAP, accuracy, recall, and F1 score. In this study, we identified a learning method conducive to polyp detection in video laryngoscopy under both white-light and narrow-band imaging. The promising detection performance holds the potential to improve diagnostic proficiency and decrease the likelihood of missed diagnoses among primary otolaryngologists. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Discussion The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub‐analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs. direct laryngoscopy to determine the number of tracheal intubations with a hyperangulated videolaryngoscope blade needed to provide an acceptable first‐attempt success rate.We included clinicians from a randomised controlled trial who were familiar with direct laryngoscopy and Macintosh‐blade videolaryngoscopy but inexperienced with hyperangulated videolaryngoscopy. Cumulative sum statistics were used to generate learning curves with acceptable success rates of 85% and unacceptable success rates of 70% for the primary outcome of first‐attempt tracheal intubation success.We included 223 clinicians (25 consultants; 35 certified registered nurse anaesthetists; 36 student registered nurse anaesthetists; 46 fellows; and 81 residents) who attempted tracheal intubation in 4312 procedures. The median (IQR [range]) number of tracheal intubations per clinician was 15 (8–25 [1–77]). First‐attempt failure was low, with only 72 failed first attempts overall, and was comparable across clinician groups. In total, 133 (60%) clinicians crossed the acceptable success rate boundary while the remaining 90 (40%) clinicians crossed neither the acceptable nor unacceptable success rate boundaries. Among clinicians who crossed the acceptance boundary, the median (IQR [range]) number of attempts for learning was 12 (12–12 [12–26]).Clinicians experienced in tracheal intubation with direct laryngoscopy but unfamiliar with hyperangulated‐blade videolaryngoscopy can achieve proficiency after approximately 12 attempts. [ABSTRACT FROM AUTHOR]

Simple Summary: The number of patients diagnosed with cancer is expected to increase in the coming years. This is attributable, among other factors, to demographic shifts in the population. It is anticipated that the number of individuals surviving cancer for an extended period will rise considerably in the future, reflecting the advances made in medical treatment. It is therefore likely that these patients will require further surgical procedures in the future, which will necessitate advanced airway management. The objective of this study is to examine the effects of radiotherapy for nasopharyngeal cancer (NPC) on the airway management performed by anesthetists. The findings of our study suggest that a notable proportion of patients with NPC will necessitate further surgical procedures throughout the course of their illness. Our study demonstrate that radiotherapy for NPC does not result in severe impairment to advanced airway management. Background: At present, there is a paucity of data in the literature pertaining to the impact of radiotherapy (RT) on the success of tracheal intubation in patients with nasopharyngeal cancer (NPC). The aim of this study is to investigate the frequency of difficult tracheal intubation in patients with NPC following RT. Methods: Patients with NPC who underwent RT followed by surgery between 2012 and April 2024 at the University Hospital Heidelberg were retrospectively analyzed. Results: Twenty-three patients, predominantly males (73.9%) with a mean age of 52.9 years, were enrolled. Overall, 65.2% of the patients had an American Society of Anesthesiologists (ASA) class of III. The mean total laryngeal dose was 53.5 Gy for the main and boost plan, and the maximum total laryngeal dose was 66.61 Gy. Direct laryngoscopy was performed in 69.6% of cases, followed by 26.1% videolaryngoscopy, and 4.2% required fiberoptic intubation. In total, 47.8% of the patients had a Cormack/Lehane grade of I, followed by 43.5% with grade II and 8.7% with grade III. Overall, 87% of patients were successfully intubated on the first attempt. Conclusions: It has been demonstrated by previous studies that RT has the potential to enhance complications and difficulties encountered during airway management. While the results must be interpreted with caution, our study provides no evidence of severe impairment in advanced airway management in patients with nasopharyngeal cancer who have undergone radiotherapy. [ABSTRACT FROM AUTHOR]

Summary: Introduction: There is uncertainty about the optimal videolaryngoscope for awake tracheal intubation in patients with anticipated difficult airway. The use of channelled and unchannelled videolaryngoscopy has been reported, but there is a lack of evidence on which is the best option. Methods: We conducted a randomised clinical trial to compare the efficacy of the C‐MAC D‐Blade® vs. Airtraq® in adult patients (aged ≥ 18 y) scheduled for elective or emergency surgery under general anaesthesia with anticipated difficult airway who required awake tracheal intubation under local anaesthesia and conscious sedation. The primary endpoint was the first‐attempt tracheal intubation success rate. Secondary outcomes included the overall success rate; number of tracheal intubation attempts; Cormack and Lehane glottic view; level of difficulty (visual analogue score); patient discomfort (visual analogue score); and incidence of complications. Results: Ninety patients (70/90 male (78%); mean (SD) age 65 (12) y) with anticipated difficult airways were randomly allocated to C‐MAC D‐Blade or Airtraq videolaryngoscopy. First‐attempt successful tracheal intubation rate was higher in patients allocated to the C‐MAC D‐Blade group compared with those allocated to the Airtraq group (38/45 (84%) vs. 28/45 (62%), respectively; p = 0.006). The proportion of patients' tracheas that were intubated at the second and third attempt was 4/45 (9%) and 3/45 (7%) in those allocated to the C‐MAC D‐Blade group compared with 14/45 (31%) and 1/45 (2%) in those allocated to the Airtraq group (p = 0.006). There was no significant difference in overall tracheal intubation success rate (C‐MAC D‐Blade group 45/45 (100%) vs. Airtraq group 43/45 (96%), p = 0.494). Discussion: In patients with anticipated difficult airway, first‐attempt awake tracheal intubation success rate was higher with the C‐MAC D‐Blade compared with Airtraq laryngoscopy. No difference was found between the two videolaryngoscopes in overall tracheal intubation success rate. [ABSTRACT FROM AUTHOR]

Abstarct Background The optimal positioned double-lumen endotracheal tubes (DLT) is crucial in thoracic surgery requiring lung isolation. This study aims to compare the accuracy and complication rates of DLT placement using videolaryngoscopy (VL) versus conventional direct laryngoscopy (DL). Methods This retrospective single-center study included 89 patients who underwent thoracic surgery with DLT placement between July 2023 and May 2024. Patients were divided into two groups: VL (n = 45) and DL (n = 44). Patient characteristics, intubation times, malposition rates, and complications were recorded. DLT position was confirmed using fiberoptic bronchoscopy. Results The incidence of DLT malposition was significantly lower in the VL group (13.3%) compared to the DL group (31.8%) (p = 0.037). The overall complication rate was also lower in the VL group (4.4%) compared to the DL group (11.4%) (p = 0.024). The mean time from anesthesia induction to the first incision was shorter in the VL group (25.2 ± 6.1 min) than in the DL group (28.3 ± 6.5 min) (p = 0.02). Conclusions VL significantly reduces the incidence of DLT malposition and associated complications in thoracic surgery compared to DL. The improved visualization and multiple blade options of the C-MAC videolaryngoscopy set likely contribute to these findings. Further research is warranted to confirm these results in larger, multicenter studies. Trial registration Institutional Review Board (Registration number: 80576354-050-99/437, 27.06.2024).

Abstract Background and objective Following thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery. Methods This research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points. Results The voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P

Summary: Background: Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer‐associated airway trauma. Methods: PubMed, EMBASE and CINAHL databases were searched using pre‐determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments. Results: We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2–31.4 [0.5–79.2])% and with bougies was 5.4% (0.4–49.9 [0.0–68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non‐robust measurement of the outcome. Conclusions: Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma. [ABSTRACT FROM AUTHOR]

Tracheal tube introducers are commonly used by anaesthetists for airway management, especially in difficult cases. They are recommended in airway management guidelines and should be readily available in operating theatres, intensive care units, and emergency departments. Tracheal tube introducers are particularly useful with videolaryngoscopy, aiding in directing the tracheal tube tip towards the glottis. A systematic review of airway trauma associated with tracheal tube introducers found that the standard stylet was the most common introducer and had a higher incidence of airway injury compared to other introducers. However, the review had limitations in terms of study heterogeneity and risk of bias. The use of tracheal tube introducers should be considered thoughtfully, and further research is needed to compare different introducer devices and assess the frequency and severity of airway trauma. [Extracted from the article]

Background and objective: Following thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery. Methods: This research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points. Results: The voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion "bilateral vocal fold nodules." The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001). Conclusion: Thyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally. [ABSTRACT FROM AUTHOR]

Endotracheal intubation is a common lifesaving procedure that often is performed outside the operating room in a variety of clinical scenarios. Providers who perform intubation outside the operating room have variable degrees of training, skill development, and experience. A large number of studies were published in 2023 on the topic of intubations outside the operating room across a wide variety of settings and patient populations. Here, we review relevant papers on this topic published in 2023. [ABSTRACT FROM AUTHOR]

Summary: Aspiration of gastric contents is a recognised complication during all phases of anaesthesia. The risk of this event becomes more likely with repeated attempts at tracheal intubation. There is a lack of clinical data on the effectiveness of videolaryngoscopy relative to direct laryngoscopy rapid sequence intubation in the operating theatre. We hypothesised that the use of a videolaryngoscope during rapid sequence intubation would be associated with a higher first pass tracheal intubation success rate than conventional direct laryngoscopy. In this multicentre randomised controlled trial, 1000 adult patients requiring tracheal intubation for elective, urgent or emergency surgery were allocated randomly to airway management using a McGrath™ MAC videolaryngoscope (Medtronic, Minneapolis, MN, USA) or direct laryngoscopy. Both techniques used a Macintosh blade. First‐pass tracheal intubation success was higher in patients allocated to the McGrath group (470/500, 94%) compared with those allocated to the direct laryngoscopy group (358/500, 71.6%), odds ratio (95%CI) 1.31 (1.23–1.39); p < 0.001. This advantage was observed in both trainees and consultants. Cormack and Lehane grade ≥ 3 view occurred less frequently in patients allocated to the McGrath group compared with those allocated to the direct laryngoscopy group (5/500, 1% vs. 94/500, 19%, respectively; p < 0.001). Tracheal intubation with a McGrath videolaryngoscope was associated with a lower rate of adverse events compared with direct laryngoscopy (13/500, 2.6% vs. 61/500, 12.2%, respectively; p < 0.001). These findings suggest that the McGrath videolaryngoscope is superior to a conventional direct laryngoscope for rapid sequence intubation in the operating theatre. [ABSTRACT FROM AUTHOR]

Simple Summary: Radiotherapy is an important treatment option for esophageal cancer, in addition to surgery and chemotherapy. Ionizing radiation can cause alterations in the patient's anatomy, particularly in the larynx area, which may make advanced airway management more challenging for anesthetists. The existing literature contains data on other entities of cancer and radiotherapy and their impact on advanced airway management. However, there is a lack of data on esophageal cancer. We retrospectively analyzed patients with esophageal cancer who underwent radiotherapy followed by surgery between 2012 and 2023 in our university hospital. It has been shown in the literature that post-radiotherapy effects can increase the risk of difficult endotracheal intubation and airway complications in anesthesiology. However, our study did not indicate any evidence of impaired advanced airway management in patients with esophageal cancer after radiotherapy. (1) Background: Currently, no data are available in the literature investigating the influence of radiotherapy (RT) on endotracheal intubation success in patients with esophageal cancer. This study aims to evaluate the impact of RT on endotracheal intubation quality metrics in patients with esophageal cancer. (2) Methods: Patients with esophageal cancer who underwent RT followed by surgery between 2012 and 2023 at the University Hospital Heidelberg, Germany, were retrospectively analyzed. (3) Results: Fifty-five patients, predominantly males 65.5% with a mean age of 64 years, were enrolled. Overall, 81.8% of the patients had an ASA class of III, followed by 27.2% ASA II. The mean prescribed cumulative total dose to the primary tumor and lymph node metastasis was 48.2 Gy with a mean single dose of 1.8 Gy. The mean laryngeal total dose was 40.0 Gy. Direct laryngoscopy was performed in 80.0% of cases, followed by 12.1% videolaryngoscopy, and 7.2% required fiberoptic intubation. Overall, 96.4% of patients were successfully intubated on the first attempt. (4) Conclusions: It has been demonstrated that post-RT effects can increase the risk of airway management difficulties and complications. The results of our study did not indicate any evidence of impaired advanced airway management in patients with esophageal cancer who had undergone RT. [ABSTRACT FROM AUTHOR]

The physiological and anatomic changes in pregnancy create a series of difficulties in intubation for general anesthesia. The refore, the aim of this study was to investigate the effects on the duration of intubation of the ramped and sniffing positions in the videolaryngoscopy guidelines in the cesarean section. A total of 60 patients undergoing elective cesarean section with general anaesthesia were randoml y separated into 2 groups. Both groups were intubated with videolaryngoscopy; one group in the sniffing position with a pillow 7cm in height placed below the occiput, and the other group in the ramped position with specially designed pillows providing horizontal alignment of the external auditory meatus and sternal notch. The intubation times were compared between the groups. The total intubation time was determined to be statistically significantly shorter in the ramped position (11.80 ± 2.30 s) than in the sniffing position (14.06 ± 1.86 s) (p<0.001). The laryngoscopy time was significantly shorter in the ramped position group (5.61±1.22 s) than in the sniffing position group (7.37±1.48 s) (p<0.001), and the tube i nsertion time was similar in both groups (p>0.117) To be able to prevent desaturation which can develop rapidly in rapid intubation because of the reduced functional residual capacity and increased oxygen consumption in pregnancy, the ramped position may be a better option than the sniffing position in pregnant patients applied with tracheal intubation with videolaryngoscopy in cesarean section surgery. [ABSTRACT FROM AUTHOR]

Airway management is a critical intervention, being a challenge in complicated patients and scenarios. The development of video laryngoscopes and their great advance in availability and acceptance have redefined intubation strategies, guaranteeing effectiveness, safety and speed. The need to have an airway management algorithm under videolaryngoscopy that meets the current parameters of guaranteeing patient safety, always avoiding complications in the peri-intubation period, should be ideal in all critical areas (anesthesiology, critical medicine, emergency medicine). Taking into account the characteristics of critical or severe patients, it is necessary to have guidelines or action plans that allow the adoption of these devices as a management standard without losing sight of a multidisciplinary care approach in airway management. An easy-to-remember and apply algorithm optimized for video laryngoscopes is presented, based on four critical pillars: oxygenation-ventilation, hemodynamic status, acid base and neuromonitoring and with the recommendation of guaranteeing a single intubation attempt always assisted by a bougie during videolaryngoscopy. [ABSTRACT FROM AUTHOR]

Airway management is undertaken to deliver oxygen, remove carbon dioxide and protect against pulmonary aspiration. This article describes the equipment utilized by airway providers in order to achieve these aims, aided by their relevant knowledge, skills and experience. The use of this equipment forms the basis of core airway management techniques, including facemask ventilation, use of supraglottic airway devices, laryngoscopy, awake tracheal intubation and front-of-neck access. [ABSTRACT FROM AUTHOR]

Cleft lip and palate (CLCP) surgeries necessitate precise airway management, especially in pediatric cases with anatomical variations. The Covid-19 pandemic posed unprecedented challenges to anesthesiology practices that required adaptations to ensure patient safety and minimize viral transmission. Videolaryngoscopy (VL) emerged as a valuable tool in airway management during the pandemic, offering improved intubation success rates and reduced aerosol generation risks. This retrospective study compared anesthesiology practices in CLCP surgeries before (2015–2019) and during the Covid-19 (2019–2022) pandemic at a tertiary care center. Patient demographics, anesthesia techniques, intubation difficulty, airway management, and intraoperative and postoperative follow-up were analyzed from anesthesia records. This study included 1282 cases. Demographics were similar between periods. During the pandemic, there was a significant decrease in the number of patients under one year old (p < 0.001) and a higher prevalence of micrognathia and comorbidities (p = 0.001 and p = 0.038, respectively). Difficult intubation and intraoperative complication rates decreased during the pandemic, but they were not statistically significant. VL usage during the pandemic contributed to improved extubating success (p < 0.001). VL usage and improved patient outcomes were observed during the pandemic, potentially due to proactive measures and infection control protocols. Decision-making processes for extubation and intensive care unit stay became crucial during the pandemic. Understanding the role of VL and its adaptations during the Covid-19 pandemic is vital for optimizing perioperative care in CLCP surgeries and other procedures requiring airway management. The findings highlight the resilience of healthcare systems and the importance of evidence-based practices under challenging circumstances. [ABSTRACT FROM AUTHOR]

Summary: Universal use of Storz C‐MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first‐pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First‐pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non‐theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. > 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no‐PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non‐theatre 7/136, p < 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non‐RSI 1/720 (0.1%), p = 0.008). [ABSTRACT FROM AUTHOR]

Background: In recent years, videolaryngoscopy has increasingly been utilized as an alternative to fiberoptic bronchoscopy in awake intubation. Nonetheless, it remains uncertain whether videolaryngoscopy represents a viable substitute for fiberoptic bronchoscopy. We conducted this systematic review with a meta-analysis to compare videolaryngoscopy and fiberoptic bronchoscopy for awake intubation. Methods: We systematically searched for all randomized controlled trials (RCTs) comparing videolaryngoscopy and fiberoptic bronchoscopy for awake intubation. The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE were systematically queried through August 2023. Our primary outcome measure was the duration of intubation. Secondary outcomes encompassed the rate of successful intubation on the initial attempt, failed intubation, patient-reported satisfaction, and any complications or adverse events potentially stemming from the intubation procedure. The Cochrane Risk of Bias Tool for RCTs was employed to evaluate all studies for evidence of bias. The GRADE approach was utilized to gauge the certainty of the evidence. Results: Eleven trials involving 873 patients were ultimately included in our review for data extraction. Meta-analysis demonstrated that videolaryngoscopy decreased the duration of intubation compared to fiberoptic bronchoscopy (SMD −1.9671 [95% CI: −2.7794 to −1.1548] p < 0.0001), a finding corroborated in subgroup analysis by the type of videolaryngoscope (SMD −2.5027 [95% CI: −4.8733 to −0.1322] p = 0.0385). Additionally, videolaryngoscopy marginally lowered the risk of experiencing a saturation below 90% during the procedure (RR −0.7040 [95% CI: −1.4038 to −0.0043] p = 0.0486). No statistically significant disparities were observed between the two techniques in terms of failed intubation, initial successful intubation attempt, or sore throat/hoarseness. With regard to patient-reported satisfaction, a pooled analysis was precluded due to the variability in evaluation methods employed across the trials to assess this outcome. Lastly, trial sequential analysis (TSA) conducted for intubation time (primary outcome) affirmed the conclusiveness of this evidence; TSA performed for secondary outcomes failed to yield conclusive evidence, indicating the necessity for further trials. Conclusions: Videolaryngoscopy for awake tracheal intubation diminishes intubation time and the risk of experiencing a saturation below 90% compared to fiberoptic bronchoscopy. [ABSTRACT FROM AUTHOR]

Background: The geometry of a laryngoscope's blade determines the forces acting on the pharyngeal structures to a relevant degree. Knowledge about the force distribution along the blade may prospectively allow for the development of less traumatic blades. Therefore, we examined the forces along the blades experienced during laryngoscopy with the C-MAC D-BLADE and blades of the Macintosh style. We hypothesised that lower peak forces are applied to the patient's pharyngeal tissue during videolaryngoscopy with a C-MAC D-BLADE compared to videolaryngoscopy with a C-MAC Macintosh-style blade and direct laryngoscopy with a Macintosh-style blade. Beyond that, we assumed that the distribution of forces along the blade differs depending on the respective blade's geometry. Methods: After ethical approval, videolaryngoscopy with the D-BLADE or the Macintosh blade, or direct laryngoscopy with the Macintosh blade (all KARL STORZ, Tuttlingen, Germany), was performed on 164 randomly assigned patients. Forces were measured at six positions along each blade and compared with regard to mean force, peak force and spatial distribution. Furthermore, the duration of the laryngoscopy was measured. Results: Mean forces (all p < 0.011) and peak forces at each sensor position (all p < 0.019) were the lowest with the D-BLADE, whereas there were no differences between videolaryngoscopy and direct laryngoscopy with the Macintosh blades (all p > 0.128). With the D-BLADE, the forces were highest at the blade's tip. In contrast, the forces were more evenly distributed along the Macintosh blades. Videolaryngoscopy took the longest with the D-BLADE (p = 0.007). Conclusions: Laryngoscopy with the D-BLADE resulted in significantly lower forces acting on pharyngeal and laryngeal tissue compared to Macintosh-style blades. Interestingly, with the Macintosh blades, we found no advantage for videolaryngoscopy in terms of force application. [ABSTRACT FROM AUTHOR]

The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department.

Abstract Background While awake, flexible bronchoscopic intubation has long been considered the gold standard for managing anticipated difficult airways, the videolaryngoscope has emerged as a viable alternative. In addition, the decision to perform awake intubation or to proceed with airway management after induction of general anesthesia should be grounded in a comprehensive assessment of risks and benefits. Case presentation A 41-year old female patient was scheduled for excision of bilateral, mobile, and pedunculated masses on both aryepiglottic folds, which covered almost the entire upper part of the glottis. We conducted a comprehensive evaluation of the patient’s signs and symptoms, which included neither stridor nor dyspnea in any position, along with the otolaryngologist’s opinion and the findings from the laryngeal fiberscopic examination. Given the potential challenges and risks associated with awake flexible bronchoscopic intubation for this patient, we decided to proceed with gentle tracheal intubation using a videolaryngoscope under general anesthesia. In case of failed mask ventilation and tracheal intubation, we had preplanned strategies, including awakening the patient or performing an emergent tracheostomy, along with preparations to support these strategies. Ensuring that mask ventilation was maintained with ease, the patient was sequentially administered intravenous propofol, remifentanil, and rocuronium. Under sufficient depth of anesthesia, intubation using a videolaryngoscope was successfully performed without any complications. Conclusions Videolaryngoscopic intubation after induction of general anesthesia can be a feasible alternative for managing difficult airways in patients with supraglottic masses. This approachshould be based on a comprehensive preoperative evaluation, adequate preparation, and preplanned strategies to address potential challenges, such as inadequate oxygenation and unsuccessful tracheal intubation.

Summary: While videolaryngoscopy has resulted in better overall success rates of tracheal intubation, airway assessment is still an important prerequisite for safe airway management. This study aimed to create an artificial intelligence model to identify difficult videolaryngoscopy using a neural network. Baseline characteristics, medical history, bedside examination and seven facial images were included as predictor variables. ResNet‐18 was introduced to recognise images and extract features. Different machine learning algorithms were utilised to develop predictive models. A videolaryngoscopy view of Cormack‐Lehane grade of 1 or 2 was classified as 'non‐difficult', while grade 3 or 4 was classified as 'difficult'. A total of 5849 patients were included, of whom 5335 had non‐difficult and 514 had difficult videolaryngoscopy. The facial model (only including facial images) using the Light Gradient Boosting Machine algorithm showed the highest area under the curve (95%CI) of 0.779 (0.733–0.825) with a sensitivity (95%CI) of 0.757 (0.650–0.845) and specificity (95%CI) of 0.721 (0.626–0.794) in the test set. Compared with bedside examination and multivariate scores (El‐Ganzouri and Wilson), the facial model had significantly higher predictive performance (p < 0.001). Artificial intelligence‐based facial analysis is a feasible technique for predicting difficulty during videolaryngoscopy, and the model developed using neural networks has higher predictive performance than traditional methods. [ABSTRACT FROM AUTHOR]

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BackgroundClinical airway screening tests used to predict difficulties during airway management have low sensitivity and specificity. Point-of-care airway ultrasound has described measurements related to problems with difficult direct laryngoscopy. Nevertheless, the correlation between ultrasound parameters and videolaryngoscopy has not been published yet. The aim of this multicenter, prospective observational pilot study was to evaluate the applicability of clinical parameters and ultrasound measurements to find potential tracheal intubation difficulties when videolaryngoscopy is used.MethodsPreoperatively, six clinical airway assessments were performed: (1) modified Mallampati score, (2) thyromental distance, (3) sternomental distance, (4) interincisal distance, (5) upper lip bite test, and (6) neck circumference. Six ultrasound parameters were measured in awake patients: (1) distance from skin to hyoid bone, (2) distance from skin to epiglottis, (3) hyomental distance in neutral head position, (4) hyomental distance in head-extended position, (5) distance from skin to the deepest part of the palate, and (6) sagittal tongue area. And finally, there was one ultrasound measure obtained in anesthetized patients, the compressed sagittal tongue area during videolaryngoscopy. The difficulty for tracheal intubation using a McGrath™ Mac videolaryngoscope, the percentage of glottic opening, and Cormack-Lehane grade were also assessed.ResultsIn this cohort of 119 subjects, tongue dimensions, particularly the sagittal tongue area, showed a robust association with increased intubation difficulty using videolaryngoscopy. A multiparametric model combining the following three ultrasound variables in awake patients: (a) the distance from skin to epiglottis, (b) the distance from skin to the deepest part of the palate, and (c) the sagittal tongue area, yielded a sensitivity of 92.3%, specificity of 94.5%, positive predictive value of 82.8%, and negative predictive value of 97.8% (p

The purpose of the study was to assess the diagnostic value of endoscopic autofluorescence imaging (AFI) in patients with premalignant lesions and primary laryngeal/hypopharyngeal cancer.Material and Methods. The diagnostic value of AFI was assessed in 53 patients with chronic hyperplastic laryngeal/hypopharyngeal lesions and 48 patients with laryngeal/hypopharyngeal cancer.Results. The inclusion of video laryngoscopy with AFI in the algorithm for examining patients with chronic diseases of the upper respiratory tract made it possible to significantly improve the diagnostic efficacy of endoscopic examination in patients with premalignant lesions (high grade dysplasia) of the laryngeal mucosa. Video laryngoscopy with AFI was found to achieve higher sensitivity, specificity and accuracy rates than white light video laryngoscopy (87.5, 96.9 and 92.5 vs 50.0, 96.0 and 71.7 %, respectively, p

The GlideScope® is a videolaryngoscope manufactured by Verathon Medical (Bothell, WA, USA), now widely used to manage planned or unexpected difficult orotracheal intubation situations. According to the current literature, GlideScope® has been used for surgical procedures involving the tongue base, such as biopsies and radiofrequency treatment of obstructive sleep apnea. We describe a case of dual use of GlideScope for pointed foreign body removal in an emergency department. [ABSTRACT FROM AUTHOR]

Objective: To describe initial experience with use of the Glidescope Go videolaryngoscope by an Australian neonatal pre‐hospital and retrieval service. Methods: We conducted a 31‐month retrospective review of an airway registry for neonates intubated by MedSTAR Kids clinicians. Results: Twenty‐two patients were intubated using the Glidescope Go, compared with 50 using direct laryngoscopy. First‐pass success was 17/22 (77.3%) with the Glidescope Go and 38/50 (76%) with direct laryngoscopy. Complications occurred in 7/22 (32%) and 8/50 (16%), respectively. Conclusions: On initial review of this practice change, videolaryngoscopy allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a pre‐hospital and retrieval setting. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. Methods: Fifty ASA II...III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24...hours following extubation. Results: The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p...=...0.024; p...=...0.012; p...=...0.030; p...=...0.009, respectively). In group analyses, T1...T2, T2...T3 and T1...T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1...T3) (p...=...0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p...

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. [ABSTRACT FROM AUTHOR]

Background: During endotracheal intubation, there is a 10% incidence of difficult laryngoscopy, which may result in serious complications. It is important to obtain as much information about the visibility of laryngeal structures before the patient is anaesthetised. Performing awake (video-) laryngoscopy on a patient is uncomfortable and can trigger gagging and coughing reflexes, making visualisation nearly impossible. The objective of this study is to evaluate the effectiveness of a soft mist spray device for airway anaesthesia during awake (video-) laryngoscopy. Methods: Twenty healthy volunteers inhaled through the Trachospray device, which was placed in their mouths. Two 2 mL syringes containing lidocaine at 4% were sprayed into the airway during inspiration. After several minutes, the subjects were asked to perform a videolaryngoscopy on themselves until the glottic structures and the vocal cords were visible. Upon completion of the procedure, all participants were asked to fill out a feedback form. Results: The duration of the videolaryngoscopy to visualisation of the vocal cords averaged 17 ± 13 s. After analysing the data, three distinct groups emerged as follows: Group 1 (70% of participants) showed no response, allowing for easy insertion of the videolaryngoscope. Group 2 (25% of participants) exhibited a light response but still permitted easy insertion and visualisation. One patient demonstrated a clear response with noticeable laryngeal contraction, requiring slightly more effort and discomfort for insertion. In 80% of the participants, the laryngeal structures were visualised according to Cormack–Lehane grade 1. All participants reported a high level of comfort, with an average rating of NRS 8. The anaesthesiologist assessed the level of anaesthesia as good to very good. No adverse events were observed. Conclusions: The Trachospray provided good, reliable, comfortable, and safe topical anaesthesia for awake videolaryngoscopy. This enables a direct visual assessment of the airway and may assist in making decisions regarding airway management for tracheal intubation. [ABSTRACT FROM AUTHOR]

Background- Difficulties in airway management increase the risk of hypoxia, which can also lead to devastating neurological outcome. Objective- To compare Kingvision and Truview Video Laryngoscope with respect to Hemodynamic changes and intubation quality in difficult intubation. Methods- After obtaining approval from the Institutional Ethic Committee, the present, prospective, randomized study "assessment of Kingvision video laryngoscope vs Truview video laryngoscope with respect to hemodynamic changes and intubation quality in patients with presumptive difficult intubation." was conducted in the Post-Graduate Department of Anaesthesiology and Intensive care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu over a period of one year. 80 patients undergoing elective surgery requiring tracheal intubation were randomly assigned to undergo intubation using Kingvision, Truview to compose equal groups of 40 each. All intubations were performed by a senior anesthesiologist who has an experience of at least 40 intubations in patients using VL. Results- Majority of the patients were in the age group of 20-50 years; Kingvision (33;82.5%), Truview (33;82.5%). Mean age ±SD in Kingvision group was 39.65±11.51 years, Truview group was 40.05±10.59 years. All groups were comparable with respect to mean age (p=0.784). Female patients dominated the Kingvision group while male dominated the Trueview. The mean time of intubation was equivalent between Kingvision and Truview group (8.95 VS 8.95 sec; p=0.083). In both groups mean heart rate increased immediately after intubation but thereafter dropped gradually to near normal till 10 minutes after intubation. The difference in both groups at different time intervals was statistically not significant. Conclusion- Although the duration of intubation was lesser in both the Kingvision and Truview video laryngoscope the difference was not statistically significant. Both the video laryngoscopes were found to be comparable in requirement of optimisation manoeuvres and need of second attempt for intubation. Hemodynamic response however was comparable in all the both laryngoscopes. [ABSTRACT FROM AUTHOR]

Pregnancy-related physiologic and anatomic changes affect oxygenation and airway management, and it is widely believed that airway difficulty may be more common in obstetric patients as a result. In addition, most obstetric intubations are performed under emergency conditions, and preoperative airway assessment poorly predicts airway management outcomes. These considerations necessitate special protocols for airway care in the obstetric population, and the evolution of the videolaryngoscope represents one of the most important milestones in recent decades. However, recommendations for the use of videolaryngoscopy in obstetrics remain unclear. A considerable body of evidence affirms that videolaryngoscopy improves laryngeal visualisation, increases first-attempt and overall intubation success rates, shortens intubation time, and facilitates team communication and education. In contrast, a significant number of studies have also reported conflicting results regarding comparative clinical outcomes and have highlighted other limitations regarding the adoption of videolaryngoscopy in routine obstetric care. Nevertheless, considering the peculiarities of obstetric intubation, the Macintosh-style videolaryngoscope can be suggested as the primary intubation device as it offers the benefits of both videolaryngoscopy and direct laryngoscopy. However, more rigorous evidence is needed to clarify the current blind spots and controversies regarding the role of videolaryngoscopy in obstetrics.

Background: Airway management in children, especially in patients with a difficult airway, remains a major challenge for anesthesiologists, pediatricians, and emergency medicine physicians. In recent years new tools have been introduced into the clinical practice. Objective: The aim was to present the current strategies for securing the airway in neonates in perinatal centers levels II and III in Germany, and to collect data on the rare event of coniotomy. Material and methods: From 5 April 2021 to 15 June 2021, physicians practicing intensive care in pediatrics and neonatology at perinatal centers levels II and III in Germany were surveyed by means of an anonymized online questionnaire. The questionnaire was designed by the authors and verified by pretesting with the help of five pediatric specialists. Contact was made digitally via the e‑mail addresses provided on the websites of the respective centers. The survey was administered through the fee for service provider LimeSurvey©. The collected data were transferred to the IBM© statistical package for the social scientists (SPSS, version 28, IBM© Corporation, Armonk, NY, USA) and statistically analyzed. Pearsonʼs χ2-test was used to perform significance testing (significance level p = < 0.05). Only completed questionnaires were included in the analysis. Results: A total of 219 participants completed the questionnaire. Available airway devices: 94.5% (n = 207) nasopharyngeal tubes, 79.9% (n = 175) video laryngoscope/fiber optic, 73.1% (n = 160) laryngeal masks, 64.8% (n = 142) oropharyngeal tube (Guedel). Of the participants 6 (2.7%) performed coniotomy (⌀ 1.6 children). Out of six cases five (83.3%) were resuscitation situations caused by complex anatomical malformations. Training of coniotomy was not provided in 98.6% (n = 216). A Standard Operating Procedure (SOP) for difficult airway in neonates was possessed by 20.1% (n = 44). Conclusion: The comparison with international studies showed that the equipment of German perinatal centers is above average. The trend towards acquisition of a video laryngoscope and its importance in clinical routine could be confirmed by our data; however, the fact that 20% of the respondents did not have access to video laryngoscopy suggests that further acquisitions will have to be made here in the future. Front of neck access (FONA) methods remain a critically questioned component of neonatal difficult airway algorithms due to their rarity and the resulting lack of data. In summary of the recommendations of the British Association of Perinatal Medicine (BAPM) and the collected data on the theoretical and practical education of the FONA methods in Germany, the implementation of the FONA methods by pediatricians and neonatologists cannot be recommended. As most resuscitation situations were caused by complex anatomical malformations, the early detection of such malformations by means of high-resolution ultrasound seems to be of particular importance. With improvement of early detection, neonates with potentially unmanageable airway problems can be left on uteroplacental circulation for a prolonged period in order to perform necessary interventions, such as tracheostomy, bronchoscopy, or extracorporeal membrane oxygenation (ECMO) device known as the ex utero intrapartum treatment (EXIT) procedure. [ABSTRACT FROM AUTHOR]

Background: Tracheal intubation in critical care is a high-risk procedure requiring significant expertise and airway strategy modification. We hypothesise that awake tracheal intubation is associated with a lower incidence of severe adverse events compared to standard tracheal intubation in critical care patients. Methods: Records were acquired for all tracheal intubations performed from 2020 to 2022 for critical care patients at a tertiary hospital. Each awake tracheal intubation case, using a videolaryngoscope with a hyperangulated blade (McGrath® MAC X-Blade), was propensity matched with two controls (1:2 ratio; standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL) undergoing general anaesthesia). The primary endpoint was the incidence of adverse events, defined as a mean arterial pressure of <55 mmHg (hypotension), SpO2 < 80% (desaturation) after sufficient preoxygenation, or peri-interventional cardiac arrest. Results: Of the 135 tracheal intubations included for analysis, 45 involved the use of an awake tracheal intubation. At least one adverse event occurred after tracheal intubation in 36/135 (27%) of patients, including awake 1/45 (2.2%; 1/1 hypotension), VL 10/45 (22%; 6/10 hypotension and 4/10 desaturation), and DL 25/45 (47%; 10/25 hypotension, 12/25 desaturation, and 3/25 cardiac arrest; p < 0.0001). Conclusions: In this retrospective observational study of intubation practices in critical care patients, awake tracheal intubation was associated with a lower incidence of severe adverse events than anaesthetised tracheal intubation. [ABSTRACT FROM AUTHOR]

Summary: Children with difficult tracheal intubation are at increased risk of severe complications, including hypoxaemia and cardiac arrest. Increasing experience with the simultaneous use of videolaryngoscopy and flexible bronchoscopy (hybrid) in adults led us to hypothesise that this hybrid technique could be used safely and effectively in children under general anaesthesia. We reviewed observational data from the international Pediatric Difficult Intubation Registry from 2017 to 2021 to assess the safety and efficacy of hybrid tracheal intubation approaches in paediatric patients. In total, 140 patients who underwent 180 attempts at tracheal intubation with the hybrid technique were propensity score‐matched 4:1 with 560 patients who underwent 800 attempts with a flexible bronchoscope. In the hybrid group, first attempt success was 70% (98/140) compared with 63% (352/560) in the flexible bronchoscope group (odds ratio (95%CI) 1.4 (0.9–2.1), p = 0.1). Eventual success rates in the matched groups were 90% (126/140) for hybrid vs. 89% (499/560) for flexible bronchoscope (1.1 (0.6–2.1), p = 0.8). Complication rates were similar in both groups (15% (28 complications in 182 attempts) hybrid; 13% (102 complications in 800 attempts) flexible bronchoscope, p = 0.3). The hybrid technique was more likely than flexible bronchoscopy to be used as a rescue technique following the failure of another technique (39% (55/140) vs. 25% (138/560), 2.1 (1.4–3.2) p < 0.001). While technically challenging, the hybrid technique has success rates similar to other advanced airway techniques, few complications and may be considered an alternative technique when developing an airway plan for paediatric patients whose tracheas are difficult to intubate under general anaesthesia. [ABSTRACT FROM AUTHOR]

Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research. [ABSTRACT FROM AUTHOR]

The recently published INTUBE study subanalysis and DEVICE trial findings both demonstrate a clear benefit of videolaryngoscopy over direct laryngoscopy in facilitating tracheal intubation of patients in the emergency department and ICU. We consider the increasing evidence supporting the use of videolaryngoscopy, the possible reasons behind its relatively slow adoption into clinical practice, and the potential role of the hyperangulated videolaryngoscope blade. We discuss the significance of improved first-pass tracheal intubation success in reducing the overall risk of complications in critically ill patients. Additionally, we address the need for specific training in videolaryngoscopy in order to maximise patient benefit, and propose that adequate training and rehearsal opportunities in videolaryngoscopy can only be realised by widespread and regular use wherever the clinical setting. [ABSTRACT FROM AUTHOR]

Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P =0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P <0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05–1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95–1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60–1.02). In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. NCT03616054. [ABSTRACT FROM AUTHOR]

Summary: Videolaryngoscopy is a suitable alternative to flexible bronchoscopy to facilitate awake tracheal intubation. The relative effectiveness of these techniques in clinical practice is unknown. We compared flexible nasal bronchoscopy with Airtraq® videolaryngoscopy in patients with an anticipated difficult airway scheduled for awake tracheal intubation. Patients were allocated randomly to flexible nasal bronchoscopy or videolaryngoscopy. All procedures were performed with upper airway regional anaesthesia blockade and a target‐controlled intravenous infusion of remifentanil. The success rate with the allocated technique was the primary outcome. A non‐inferiority analysis with a predefined limit of 8% was planned. Seventy‐eight patients were recruited, allocated randomly and analysed. The rate of successful intubation was 97% and 82% in the flexible bronchoscopy and videolaryngoscopy groups, respectively, p = 0.032. The median (IQR [range]) time to tracheal intubation was shorter with the Airtraq, 163 (105–332 [40–1004]) vs. 217 (180–364 [120–780]) s, p = 0.030. There were no significant differences for complications found between the groups. The median visual analogue scale for ease of intubation was 8 (7–9 [0–10]) for Airtraq vs. 8 (7–9 [0–10]) for flexible bronchoscopy, p = 0.710. The median visual analogue scale for patient comfort for Airtraq was 8 (6–9 [2–10]) vs. 8 (7–9 [3–10]) for flexible bronchoscopy, p = 0.370. The Airtraq videolaryngoscope is not non‐inferior to flexible bronchoscopy for awake tracheal intubation in a clinical setting when awake tracheal intubation is indicted. It may be a suitable alternative when judged on a case‐by‐case basis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory therapists (RTs) have historically performed safe and effective intubations, yet there are limited multi-center data assessing their intubation performance. Multi-center data can be used to compare RT intubation performance to that of other professions and identify quality improvement opportunities at hospitals where RTs perform intubation. We aimed to explore the feasibility of a multi-center collaborative to evaluate RT intubation outcomes. METHODS: A data collection tool was developed by the authors and implemented at two institutions. Following institutional review board approval at each center and completion of data-use sharing agreements, data were collected between May 25, 2020--April 30, 2022, and combined for analysis. Descriptive statistics were used to compare overall success rate, first-attempt success rate, adverse events (AEs), and type of laryngoscopy. RESULTS: There were a total of 689 intubation courses where RTs made an attempt, 363 from center A and 326 from center B. Center A captured 85% of all RT intubation courses, and center B captured 63%. Overall, RTs were successful in 98% of attempts. RTs made 86% of initial attempts. The most common indications for intubation were cardiac arrest (42%) and respiratory failure (31%). Videolaryngoscopy was used during 65% of initial attempts and was associated with higher first-attempt success rate, higher overall success rate, and fewer AEs. Airway-related adverse event rate was 8.7%; physiologic AE rate was 16%, and desaturation rate was 11%. CONCLUSIONS: A collaborative examining RTs intubation performance was successfully initiated at 2 separate facilities. Intubations performed by RTs had a high success rate, with AE rates comparable to published results from other types of providers. [ABSTRACT FROM AUTHOR]