4% failure rate is really high. This makes this single center trial suspicious. In addition, video laryngoscopes are effective when the defect is an anteriorly displaced larynx. I suspect some of this difference is crossover from the DL cohort to the VL cohort when an anteriorly displaced larynx is discovered. It is true that anesthesiologists at all training levels abandon now DL in favor of VL sooner than they would have 10 or 15 years ago. This means they get little experience with other (e.g. straight Miller) blades and maneuvers which increased DL success in the past. This is how all technical advances work; the skillset that developed around the old methods atrophies. This is a good thing, generally. The problem we have observed mostly among ED and critical care practitioners, is that when the defect is not an anteriorly displaced larynx, VL can be disadvantageous. Obstructing masses, airway hemorrhage or a very distorted anatomy from perhaps radiation or trauma is often harder to identify and intubate with a VL than a DL. At our place, this has led to some really poor outcomes. Rare events to be sure, but morbid.
There is an easy solution to this - Standard geometry VL(SGVL). While CMAC is the OG SGVL brand, Glidescope also makes them. They make training airway skills so much less stressful as a staff - you just turn the screen so you can see it but the trainee cannot during the attempt. You can give them active feedback knowing exactly what they're seeing and also knowing if they goose it before you inflate the gut.
As a gas-crit I will say that (anecdotally) SGVL is also less time consuming with less futzing around than with Hyperangulated VL (HAVL) . Unless someone has a (literal) fixed neck I will reach for a SGVL 100/100 times.
I have been using mostly MAC style Glidescope blade for my intubations. It brings best of both (or even three worlds)- ability to switch to DL techinque in case of malfunction, greater ability to lift tongue and manipulate airway in VL mode, as well as use it like a Miller by pushing forward and lifting uvula. Additionally, I don’t think that technical issues are exclusively the problem associated with VL, as dead batteries and light malfunction can happen with old school DL devices as well. At some point we have to admit the obvious advantage of new technology and focus on maintaining it in proper functioning condition. The old “what if we’re back in Stone Age” adage cannot remain a rationale for teaching and maintaining obsolete techniques and technology.
4% failure rate is really high. This makes this single center trial suspicious. In addition, video laryngoscopes are effective when the defect is an anteriorly displaced larynx. I suspect some of this difference is crossover from the DL cohort to the VL cohort when an anteriorly displaced larynx is discovered. It is true that anesthesiologists at all training levels abandon now DL in favor of VL sooner than they would have 10 or 15 years ago. This means they get little experience with other (e.g. straight Miller) blades and maneuvers which increased DL success in the past. This is how all technical advances work; the skillset that developed around the old methods atrophies. This is a good thing, generally. The problem we have observed mostly among ED and critical care practitioners, is that when the defect is not an anteriorly displaced larynx, VL can be disadvantageous. Obstructing masses, airway hemorrhage or a very distorted anatomy from perhaps radiation or trauma is often harder to identify and intubate with a VL than a DL. At our place, this has led to some really poor outcomes. Rare events to be sure, but morbid.
There is an easy solution to this - Standard geometry VL(SGVL). While CMAC is the OG SGVL brand, Glidescope also makes them. They make training airway skills so much less stressful as a staff - you just turn the screen so you can see it but the trainee cannot during the attempt. You can give them active feedback knowing exactly what they're seeing and also knowing if they goose it before you inflate the gut.
As a gas-crit I will say that (anecdotally) SGVL is also less time consuming with less futzing around than with Hyperangulated VL (HAVL) . Unless someone has a (literal) fixed neck I will reach for a SGVL 100/100 times.
I have been using mostly MAC style Glidescope blade for my intubations. It brings best of both (or even three worlds)- ability to switch to DL techinque in case of malfunction, greater ability to lift tongue and manipulate airway in VL mode, as well as use it like a Miller by pushing forward and lifting uvula. Additionally, I don’t think that technical issues are exclusively the problem associated with VL, as dead batteries and light malfunction can happen with old school DL devices as well. At some point we have to admit the obvious advantage of new technology and focus on maintaining it in proper functioning condition. The old “what if we’re back in Stone Age” adage cannot remain a rationale for teaching and maintaining obsolete techniques and technology.