Avoiding Repeated Attempts at Tracheal Intubation: Can Videolaryngoscopes Be the Answer?

Abstract

Tracheal intubation is a common practice. But multiple attempts can cause airway obstruction and ensuing complications. Guidelines have strongly advised against making multiple tracheal intubation attempts. Many techniques have been described to improve the chances of successful intubation with traditional laryngoscopes (Macintosh and Miller). However, the rate of difficulty has not been significantly reduced. With the modern technological advancements, devices such as video laryngoscopes, fiberoptic bronchoscopes, supraglottic airways (as a conduit for tracheal intubation), lighted stylets, and optical stylets offer alternate options. Aziz et al developed a survey on alternate options used in instanceswhere the conventional methods such as laryngoscope had failed. The authors wanted to retrospectively ascertain the success rates of intubation using these modern devices. A total number of 1427 cases were reviewed. It was observed that video laryngoscopes had the highest success rate (92%) when compared with supraglottic airways (78%), fiberoptic bronchoscope (78%), lighted stylets (77%), and optical stylets (67%). However, because this study was retrospective, selection bias could not be ruled out, and definitive conclusion should not be drawn. Although video