The reasons 13/11/ Cost 2. Availability 3. Comparison 4. Complications 5. Knowledge. Pulmonary and critical care medicine (PCCM) fellows.
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1 The reasons Why shouldn t we use videolaryngoscope for routine intubation? Wariya Sukhupragarn, MD Associate Professor Department of Anesthesiology Faculty of Medicine, Chiang Mai University 1. Cost 2. Availability 3. Comparison 4. Complications 5. Knowledge Pulmonary and critical care medicine (PCCM) fellows. First-year residents in anesthesiology and intensive care 1
2 To sum up, in our manikin study, paramedics were able to perform endotracheal intubation in a shorter time and with more efficiency during the first attempt when they applied the Macintosh standard laryngoscope as compared with the PCD videolaryngoscope. BJA 2017 It is certainly possible that VL may slow down easy intubations, but in this and in other performance metrics it is unlikely that all VLs perform equally Our survey has shown that most UK hospitals now have at least one videolaryngoscope available. However, the results suggest that VL is used primarily as a rescue tool and rarely routinely. In addition, VL is increasingly less available in those locations where its use is likely to be more necessary COMPLICATIONS 2
3 GlideScope was used by an experienced staff anesthesiologist Intubation with a standard tip 8.0 ETT and malleable stylet was accomplished with difficulty after multiple attempts. 3
4 In our analysis, females with higher BMI contributed to the majority of injury cases, suggesting that using a smaller laryngoscope blade could reduce the potential for injury. Videolaryngoscopy introduces risk to intubation that is not shared by direct laryngoscopy KNOWLEDGE 4
5 Blind spot JCA 2010 The blade tip should be passed posterior to the epiglottis for laryngeal exposure, which is elevated directly to expose the glottis, as with other straight laryngoscopes. it is sometimes difficult to observe the epiglottis continuously because the camera is located beneath the blade tip. Consequently, the view of the epiglottis from the camera may be impeded by the blade tip and may result in undiagnosed epiglottis malposition. It is particularly important to confirm normal position of the epiglottis during withdrawal of the device to prevent this complication When this downfolding occurs, the epiglottis can become ischemic and edematous which may result in complete airway obstruction In order to facilitate the passage of the tip posterior to the epiglottis, the AWS blade should be passed along the posterior route through the airway, against the palate and posterior pharyngeal wall, as with the laryngeal mask airway insertion technique 5
6 Most of the difficulties encountered with DL are due to the inability to create an unobstructed line of sight, whereas GS failure is mostly attributed to the inability to accurately direct the ETT. Four preoperative predictors were significantly associated with GS failure: presence of airway pathology from local mass, previous surgery, reduced spinal motion, and radiation GS intubations, lengthier intubation time and multiple attempts. These variables included upper lip bite test score, sternothyroid distance, and Cormack-Lehane system class Having the VL in our airway arsenal is a great supplement, but the relative ease of use, steep learning curve greater intubation success rate creating false self-confidence reduced mastery of alternative airway skills including fiberoptic intubation. No single airway device or technique is successful in every clinical scenario The awake technique for controlling the airway in anticipated difficult airways is still the gold standard 6
7 We found statistically fewer failed intubations when a VLS was used in participants who presented with an anticipated difficult airway or a simulated difficult airway, but no difference in the number of failed intubations for participants who presented without an anticipated difficult airway Think about 1. Cost 2. Availability 3. Comparison 4. Complications 5. Knowledge THANK YOU 7
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