Abstract
The previous two chapters (Chaps. 4 and 5) discussed the limitations of line-of-sight (direct) laryngoscopy. Many of these shortcomings could be circumvented by rigid fiberoptic laryngoscopes, however, unless coupled to an external video camera, only the laryngoscopist could see, the image was small and the field of view was limited. If a camera head was attached, a more powerful external light source and monitor were required. This rather complex setup has been greatly simplified by embedding miniature video cameras into modified laryngoscope blades, illuminated by intense but low heat-emitting LEDs (light-emitting diodes) and small, dedicated, high-resolution LCD monitors. These integrated video laryngoscopes (VLs) can be battery powered and portable. Some are resistant to fogging and able to capture time-annotated images of the laryngoscopy and intubation. This chapter will describe several such devices. They will be classified as channeled devices (e.g. Airtraq and AirwayScope) or non-channeled (McGrath, GlideScope, and Storz Direct Coupled Interface [DCI]/V-MAC and C-MAC). With channeled VLs, the scope and ETT are manipulated as a single unit; the ETT is directed by adjusting the orientation of the scope. With non-channeled VLs, the scope and ETT are independently maneuvered, generally using a stylet. This is a rapidly developing field characterized by technological leapfrogging. Existing indirect VLs will be modified, new devices will appear and some may disappear. Every effort has been made to be accurate up to the time of preparation.
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Notes
- 1.
This raises the question—relevant to other video laryngoscope devices—whether such injuries are a consequence of the operator paying more attention to the display than the insertion of the device into the mouth.
- 2.
A recent publication involving 2004 patients intubated with the GVL provides some of the required evidence. Among patients in whom DL failed, 224/239 patients were successfully intubated by GVL. Likewise, 8 of 10 patients were rescued by GVL when flexible bronchoscopic intubation failed. A 98% success rate was achieved when the GVL was used as a primary device for patients with features suggesting a difficult DL. Of equal interest was the observation that success differed between the two institutions. Increased availability and use were rewarded with greater success72.
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Cooper, R.M., Lee, C. (2013). Role of Rigid Video Laryngoscopy. In: Glick, D., Cooper, R., Ovassapian, A. (eds) The Difficult Airway. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92849-4_6
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