Video-assisted laryngoscopy has revolutionized airway management. While anesthesia providers warn that the technology cannot replace the skill and training necessary to intubate a surgical patient, they admit that the ability to see “around the corner” of respiratory anatomy gives them an advantage in challenging airway situations. We asked a panel of anesthesiologists what they saw when reviewing a selection of videolaryngoscope demonstrations online, and we’ve included links to the videos they watched. Here’s what stood out to them.

— David Bernard

The Commentators

• Carlos Brun, MD, is an anesthesiologist and medical-surgical ICU co-director at the VA Palo Alto Health Care System in California.
• Gary Lawson, MD, provides anesthesia at the Adult & Children’s Surgery Center of Southwest Florida in Fort Myers.
• David Rosen, MD, is the president of Midwest Anesthesia Partners in Naperville, Ill.
• Ashish Sinha, MD, PhD, is vice chair of Anesthesiology and Perioperative medicine at Drexel University College of Medicine in Philadelphia, Pa.

The Devices

Airtraq Avant
tinyurl.com/kovmtmm

The pitch: Reusable battery-powered optics completely enclosed in a single-use, rigid plastic blade.

Dr. Brun: An optional wireless display eliminates bulk, but still allows simultaneous video and eyepiece use, which may be valuable for beginning instruction.

Dr. Rosen: A simple lightweight device, but it is big in the mouth: possible dental trauma.

Dr. Lawson: For obese patients with lots of soft tissue and a big tongue, this isn’t a good design.

Dr. Sinha: The fact that it’s disposable is an advantage and a disadvantage. When you reach for it, you know that it’s sterile. But there’s an amount of social guilt over medical waste.

Clarus Video System
tinyurl.com/lgq2scy

The pitch: A malleable stylet outfitted with an LED light source, camera and display screen.

Dr. Rosen: It’s good for small mouth openings or wired jaws. It can snake through anything. When all else fails, it’ll save the day.

Dr. Lawson: The optics section is rigid. Note that the camera end doesn’t extend beyond the endotracheal tube, so it’s not maneuverable.

Dr. Sinha: The long length (31.7 cm) is a challenge for people who aren’t very tall. But the advantage of looking right through the endotracheal tube is, you know exactly where you’re driving.

Dr. Brun: The system requires approximately 1 minute of defogging time prior to use.

Covidien McGrath MAC Enhanced Direct Laryngoscope
tinyurl.com/n34rcen

The pitch: Direct and video laryngoscopy combined in a single handpiece.

Dr. Lawson: The video shows a patient with a small mouth opening, and the blade gave a nice view, with no extra extension of the neck necessary. That would be good for patients with neck injuries, osteoarthritis or prior cervical fusion.

Dr. Rosen: The slim blade is similar to a Macintosh, which a lot of people use and are familiar with. The built-in articulating screen would make screen-teaching convenient. But the handle looks a bit bulkier in the hand than other available devices.

Karl Storz C-MAC Video Laryngoscope System
tinyurl.com/l8j5vyl

The pitch: Standard-shaped blades, a wide 160° view, adaptable to flexible or rigid fiber-optic use.

Dr. Sinha: The big screen (7 inches) is a big advantage for visibility and instruction. You see the tip of the blade at the top of the screen, which can help you orient yourself better. It’s a wired monitor, though, and wires can be unwieldy in the OR.

Dr. Rosen: The more pieces there are, the more you have to put together. A separate monitor is a separate component to turn on, to not work, to break down or to fall on the floor. I’ve often said, if you have to hook three or more things together, after a month 1 piece will be missing and you’ll have interesting, expensive paperweights.

King Vision Video Laryngoscope
tinyurl.com/6u35j5m

The pitch: Battery-operated scope’s disposable blades bring new optics, LED light and anti-fog lens to each use.

Dr. Brun: The integrated, fixed-position video monitor may make contact with poorly positioned patients who have large chests, so the device’s ability to connect via cable to a standard video monitor might prove a useful option.

Dr. Sinha: It conveniently accommodates 2 types of blades: 18 mm channeled blades, which are somewhat big but don’t require a stylet for endotracheal tube placement, and 13 mm standard blades for smaller mouth openings and freehand guiding. It seems that it would be easy to get the tube caught on the right aryepiglottic fold.

Teleflex Medical McGrath Video Laryngoscope
tinyurl.com/nqhmclh

The pitch: Portable, durable, lightweight and balanced, with 1-button operation.

Dr. Brun: It allows users to carry only 1 size of blade cover by utilizing a low-profile disposable plastic cover on a steel, pre-curved blade that is length-adjustable.

Dr. Rosen: The on-the-fly adjustable size is unique and very nice, and the attached rotating screen is useful.

Dr. Lawson: It has usefulness for teaching the anatomical landmarks, but it doesn’t show where the vocal cord is relative to the ETT cuff.

Olympus MAF Airway Mobilescope
tinyurl.com/mjer68a

The pitch: A flexible intubation endoscope with an integrated display in a standalone unit.

Dr. Brun: It has an initially non-intuitive setup, with a separate battery in back of the video monitor base. However, its lack of need for a tower offers increased fiberoptic flexibility in clinical applications, such as checking the airway position under drapes, during 180° rotation or prone position. Other considerations include a narrow, 90° field of view (typical for flexible fiber-optics) and a 120° limitation on up/down angulation.

Dr. Sinha: The swivel screen is nice. It also has the advantage of one-handed operation, which is especially useful when you’re taking pictures.

Verathon GlideScope Video Laryngoscope
tinyurl.com/mtlpqmp

The pitch: Multiple models feature single-use and reusable blade configurations for all sizes.

Dr. Rosen: This is the gold standard in non-fiberoptic-type laryngoscope devices.

Dr. Brun: Verathon recommends the use of its proprietary ETT and pre-curved stylet for the best chance of intubation success.

Dr. Sinha: Creating a stylet that exactly paralleled the shape of the blade made all the difference. Also, it has the biggest screen of them all, so it’s a great training tool. But, it’s not in the line of sight, you have to look off to the side. I have even suggested to them, put the monitor on a swivel arm, then it can be swung out above the patient, so you can look at both.