There’s no question the invention of video laryngoscopes changed the way providers tackled the critical issue of airway management. But for years after these game-changing devices hit the market, usage was limited only to those challenging cases, the ones involving “difficult” airways. Now, with providers seeing plenty of benefits beyond just the difficult airway cases, we’re witnessing another shift. “With the recognition of their role in airway management, and the increasing familiarity and popularity as well as the decrease in cost, some difficult airway guidelines now recommend the use of video laryngoscopy for all patients,” says Basem Abdelmalak, MD, FASA, an anesthesiology professor at the Cleveland Clinic Lerner College of Medicine. “These devices should be given consideration as the first-line laryngoscope to be used in certain marginally potentially difficult airway cases.”
Whenever the adoption of a certain technology or technique becomes commonplace in the OR, the standard of care question is bound to come up. But maybe that’s not the best way to look at expanded video laryngoscope usage. While Dr. Abdelmalak cites the ASA 2022 Practice Guidelines for the Management of Difficult Airways that lists video laryngoscope as a suggested content for standard anesthetizing location and says usage is getting closer to the standard of care, he also acknowledges a core truth about universal usage of the equipment. “The challenge with video laryngoscopy is that it isn’t feasible for some facilities due to the cost,” he says.
So if video laryngoscopy isn’t merely a rescue technique for difficult airways, but it isn’t quite the standard of care, how should we categorize the usage of these devices in the world of surgery? “I would call it the ‘expectation of care,’” says Ashish Sinha, MD, PhD, DABA, MBA, FASA, a professor at the University of California Riverside and designated institutional official and program director of anesthesiology at UC Riverside/Riverside Community Hospital. Dr. Sinha says the video laryngoscope frequency increases at larger teaching facilities like Mount Sinai. “If you were to go into training there, you’d be given a video laryngoscope and that’s yours for the duration of your training there, and they want you to do every [intubation] on it,” he says. “You go in the morning, and you get the blade that you need for that day.”
Indeed, the teaching potential of video laryngoscopes alone is almost reason enough to expand usage to cases well beyond those traditionally difficult airway cases. “That’s one of the greatest advantages of video laryngoscopy,” says Dr. Sinha. “You can teach a lot easier because if I’m teaching you, both you and I can look at the same image on the video screen, and I can tell you how to correct for it.”