Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Article de synthese: La video-laryngoscopie: un autre outil pour les intubations difficiles ou un nouveau paradigme pour la prise en charge des voies aeriennes? (2013)

Background An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Principal findings Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety. Conclusion The greater effectiveness of video-laryngoscopes associated with multi-person visualization could enhance overall patient safety during airway management. However, the routine use of video-laryngoscopy also introduces some issues that need to be addressed to avoid potentially dangerous pitfalls. Resume Contexte Une prise en charge adaptee des voies aeriennes est essentielle a la securite des patients. De nouvelles alternatives a la laryngoscopie directe et a l’intubation ont ete recemment developpees. Parmi elles, la video-laryngoscopie est devenue rapidement populaire et beaucoup la considerent maintenant comme la technique de premiere intention pour la prise en charge des voies aeriennes. Ce changement de paradigme pourrait avoir un impact sur la securite des patients. Constatations principales Les etudes montrent que les video-laryngoscopes sont associes a une meilleure visualisation de la glotte, un taux de reussite superieur en cas de voies aeriennes difficiles et une courbe d’apprentissage plus rapide, aboutissant a des taux de reussite plus eleves pour les intubations realisees par des medecins novices. En consequence, les intubations difficiles inattendues pourraient etre moins frequentes si la video-laryngoscopie etait utilisee comme approche de premiere intention. De plus, le suivi sur ecran par l’operateur cree une nouvelle dynamique interactive au cours de la prise en charge des voies aeriennes. Toute l’equipe de la salle d’operation peut evaluer l’evolution en temps reel, ce qui encourage la communication et ameliore l’enseignement. Cependant, si les video-laryngoscopes deviennent des outils standard pour l’intubation tracheale, ces dispositifs plus couteux doivent devenir largement disponibles dans tous les endroits ou J.-B. Paolini, MD (&) F. Donati, MD, PhD P. Drolet, MD Departement d’anesthesiologie, Universite de Montreal, Montreal, QC, Canada e-mail: jbpaolini@yahoo.fr 123 Can J Anesth/J Can Anesth (2013) 60:184–191 DOI 10.1007/s12630-012-9859-5