Technology, limitations, and applications of video laryngoscopy in orthopedic and trauma surgery
Keywords:
airway management, intratracheal intubation, laryngoscopy, laryngoscopesAbstract
Introduction: Video laryngoscopes have become standard instruments for the management of difficult airways. They are considered equivalent to flexible fiberscopes due to their effectiveness in ensuring intubation in adult and pediatric patients, both in clinical and surgical settings, and their low incidence of complications.
Objective: To describe the technological principles, limitations, and applications of video laryngoscopes.
Methods: A non-systematic literature review was conducted in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed, Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, Springer Link, and the academic search engine Google Scholar during March 2024.
Development: Expert consensus and the opinions of several surgeons, based on a methodology and adhering to defined scales, can help determine the best therapeutic option for the patient. Amputation should not be considered a failure, but rather a deliberate choice, due to the functional impact of complications after limb salvage.
Conclusions: Initial multidisciplinary treatment of a severely traumatized limb is considered a guideline in hospitals with reconstructive surgery services. In institutions without these services, orthopedists should be equipped with the necessary tools to address such contingencies.
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References
1. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiol. 2022;136(1):31-81. DOI: https://doi.org/10.1097/ALN.0000000000004002
2. Cook TM, Ogelsby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthes. 2023;79(4):368-79. DOI: https://doi.org/10.1111/anae.16187
3. Crosby ET, Duggan LV, Finestone PJ, Liu R, Gorter RD, Calder LA. Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association. Can J Anesth. 2021;68(2):183-95. DOI: https://doi.org/10.1007/s12630-020-01846-7
4. Endlich Y, Lee J, Culwick MD. Difficult and failed intubation in the first 4000 incidents reported on webAIRS. Anaesth Intensive Care. 2020;48(6):477-87. DOI: http://dx.doi.org/10.1177/0310057X20957657
5. Fornebo I, Simonsen KA, Bukholm IRK, Kongsgaard UE. Claims for compensation after injuries related to airway management: a nationwide study covering 15 years. Acta Anaesthesiol Scand. 2017;61(7):781-9. DOI: https://doi.org/10.1111/aas.12914
6. Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation. a closed claims analysis. Anesthesiol. 2019;131(4):818-29. DOI: https://doi.org/10.1097/ALN.0000000000002815
7. Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021;325(12):1164-72. DOI: https://doi.org/10.1001/jama.2021.1727
8. Heidegger T. Management of the Difficult Airway. N Eng J Med. 2021;384(19):1836-47. DOI: https://doi.org/10.1056/NEJMra1916801
9. Huitink JM, Cook TM. The epidemiology of airway management complications. En: Cook TM, Kristensen MS, editor. Core topics in airway management. 3rd ed. Cambridge University Press; 2021. p. 22-37. DOI: https://doi.org/10.1017/9781108303477.005
10. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022;2022(4):CD011136. DOI: https://doi.org/10.1002/14651858.CD011136.pub3
11. Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev. 2018;2018(6):CD00997]. DOI: https://doi.org/10.1002%2F14651858.CD009975.pub3
12. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Preanesthetic” Era, 1700 to 1846. Anesthesiol. 2016;124(2):301-11. DOI: https://doi.org/10.1097/ALN.0000000000000955
13. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Artisanal Anesthetic” Era, 1846 to 1904. Anesthesiol. 2017;126(3):394-40. DOI: https://doi.org/10.1097/ALN.0000000000001508
14. Matioc AA. An Anesthesiologist’s perspective on the history of basic airway management. The “Progressive” Era, 1904 to 1960. Anesthesiol. 2018;128(2):254-71. DOI: https://doi.org/10.1097/ALN.0000000000001975
15. Berkow LC, Morey TE, Urdaneta F. The Technology of Video Laryngoscopy. Anesth Analg. 2018;126(5):1527-34. DOI: https://doi.org/10.1213/ANE.0000000000002490
16. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anesth. 2005;52(2):191-8. DOI: https://doi.org/10.1007/BF03027728
17. Maguire S, Schmitt PR, Sternlicht E, Kofron CM. Endotracheal intubation of difficult airways in emergency settings: a guide for innovators. Med Devices Evid Res. 2023;16:183-99. DOI: https://doi.org/10.2147/MDER.S419715
18. Guzmán J. El videolaringoscopio C-MAC. Una guía para optimizar su uso ilustrando experiencias clínicas. Endo Press; 2016 [acceso 12/03/2024]. Disponible en: https://simuvad.aymonline.events/wp-content/uploads/SILVERBOOK-guia-para-optimizar-el-uso-de-videolaringoscopios-CMAC.pdf
19. Lee J, Cho Y, Kim W, Choi KS, Jang BH, Shin H, et al. Comparisons of videolaryngoscopes for intubation undergoing general anesthesia: systematic review and network meta-analysis of randomized controlled trials. J Pers Med. 2022;12:363. DOI: https://doi.org/10.3390/jpm12030363
20. Hoshijima H, Mihara T, Denawa Y, Shiga T, Mizuta K. Airtraq versus GlideScope for tracheal intubation in adults: a systematic review and meta-analysis with trial sequential analysis. Can J Anesth. 2022;69(5):605-13. DOI: https://doi.org/10.1007/s12630-022-02217-0
21. Wünsch VA, Köhl V, Breitfeld P, Bauer M, Sasu PB, Siebert HK, et al. Hyperangulated blades or direct epiglottis lifting to optimize glottis visualization in difficult Macintosh videolaryngoscopy: a non-inferiority analysis of a prospective observational study. Front Med. 2023;10:1292056. DOI: https://doi.org/10.3389/fmed.2023.1292056
22. Irouschek A, Moritz A, Kremer S, Fuchte T, Danzl A, Schmidt J, et al. An approach to difficult airway in infants: Comparison of GlideScope® Spectrum LoPro, GlideScope® Spectrum Miller and conventional Macintosh and Miller blades in a simulated Pierre Robin sequence performed by 90 anesthesiologists. PLoS One. 2023;18(8):e0288816. DOI: https://doi.org/10.1371/journal.pone.0288816
23. Kumari A, Choudhuri P, Agrawal N. A comparative study of the C-MAC D-blade videolaryngoscope and McCoy laryngoscope for oro-tracheal intubation with manual in-line stabilization of neck in patients undergoing cervical spine surgery. J Anaesth Clin Pharm. 2022;39(3):435-43. DOI: https://doi.org/10.4103/joacp.joacp_471_21
24. Singleton BN, Morris FK, Yet B, Buggy DJ, Perkins ZB. Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis. Br J Anaesth. 2021;126(5):1055-66. DOI: https://doi.org/10.1016/j.bja.2020.12.041
25. Correa JBB, Felice VB, Sbruzzi G, Friedman G. Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis. Emerg Med J. 2023;40:300-7. DOI: https://doi.org/10.1136/emermed-2021-211160
26. Moraes ACBK, Nascimento CdDd, Souza EG, Kraemer MB, Moraes M, Carreno NLV, et al. Advancements in additive manufacturing for video laryngoscopes: a comprehensive scoping and technological review. Syst Rev. 2023;12:236. DOI: https://doi.org/10.1186/s13643-023-02406-y
27. Cheong CC, Ong SY, Lim SM, Wan WZ, Mansor M, Chaw SH. Partial vs full glottic view with CMACTM D-blade intubation of airway with simulated cervical spine injury: a randomized controlled trial. Expert Rev Med Devices. 2023;20(2):151-60. DOI: https://doi.org/10.1080/17434440.2023.2174850
28. Popal Z, Dankert A, Hilz P, Wünsch VA, Grensemann J, Plümer L, et al. Glidescope video laryngoscopy in patients with severely restricted mouth opening. A pilot study. J Clin Med. 2023;12:5096. DOI: https://doi.org/10.3390/jcm12155096
29. Khader A, Singh T, Singh A, Kour A. Comparing Intubating conditions and stress response with CMAC D-Blade and McCoy laryngoscope: A guide to new anesthetists. Apollo Med. 2023;20(3):196-202. DOI: https://doi.org/10.4103/am.am_160_22
30. Sbeghen V, Verdonck O, McDevitt J, Zaphiratos V, Brulotte V, Loubert C, et al. A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anesth. 2021;68(6):855-67. DOI: https://doi.org/10.1007/s12630-021-01936-0
31. Hindman BJ, Dexter F, Gadomski BC, Bucx MJ. Sex-Specific intubation biomechanics: intubation forces are greater in male than in female patients, independent of body weight. Cureus. 2020;12(6):e8749. DOI: https://doi.org/10.7759/cureus.8749
32. Gadomski BC, Shetye SS, Hindman BJ, Dexter F, Santoni BG, Todd MM, et al. Intubation biomechanics: validation of a finite element model of cervical spine motion during endotracheal intubation in intact and injured conditions. J Neurosurg Spine. 2018;28(1): 10-22. DOI: https://doi.org/10.3171/2017.5.SPINE17189
33. Hindman BJ, Fontes RB, From RP, Traynelis VC, Todd MM, Puttlitz CM, et al. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers - effect of severe distractive-flexion injury on C3–4 motion. J Neurosurg Spin. 2016;25(5):545-55. DOI: https://doi.org/10.3171/2016.3.SPINE1640
34. Fonternel T, Rooyen Hv, Joubert G, Turton E. Evaluating the Usability of a 3D-Printed video laryngoscope for tracheal intubation of a manikin. Med Devices Evid Res. 2023;16:157-65. DOI: https://doi.org/10.2147/MDER.S405833
35. Gorman L, Dickson AN, Monaghan M, Vaughan F, Murphy B, Dowling DP, et al. Novel co-axial, disposable, low-cost 3D printed videolaryngoscopes for patients with COVID-19: a manikin study. Eur J Anaesthesiol Intensive Care Med. 2022;2(1):e0015. DOI: https://doi.org/10.1097/EA9.0000000000000015
36. Choi J, Song Y, Lee H, Cho Y, Ha TH, Lim TH. Comparison of the strength of various disposable videolaryngoscope blades. Can J Anesth. 2021;68:1651-8. DOI: https://doi.org/10.1007/s12630-021-02069-0
37. Hamal PK, Chaurasia RB, Pokhrel N, Pandey D, Shrestha GS. An affordable videolaryngoscope for use during the COVID-19 pandemic. Lancet Glob Health. 2020;8(7):e893-e4. DOI: https://doi.org/10.1016/S2214-109X(20)30259-X
38. Freitas JD, Moreno JE, Silva M. Prototipo de videolaringoscopio: Wi-Mac-Multivision. Rev Chil Anest. 2020;49:262-70. DOI: https://doi.org/10.25237/revchilanestv49n02.11
39. Karippacheril JG, Cong ML. Videolaryngoscopy using an Android smartphone: A direct digital technique. Indian J Anaesth. 2016;60(2):143-5. DOI: https://doi.org/10.4103/0019-5049.176288
40. Karippacheril JG, Umesh G, Ramkumar V. Inexpensive video-laryngoscopy guided intubation using a personal computer: initial experience of a novel technique. J Clin Monit Comput. 2014;28(3):261-4. DOI: https://doi.org/10.1007/s10877-013-9522-x
41. HamalI PK, Yadav RK, Malla P. Performance of custom made videolaryngoscope for endotracheal intubation: A systematic review. PLoS One. 2022;17(1):e0261863. DOI: https://doi.org/10.1371/journal.pone.0261863
42. Lotlikar A, Hoogenboom EM. Importance of standardisation and human factors in ensuring patient safety with videolaryngoscopes. Anaesthesia. 2024;79(1):103-4. DOI: https://doi.org/10.1111/anae.16126
43. Sukmono B, Manggala SK, Auerkari AN, Christina B. Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial. Indian J Anaesth. 2022;66(5):350-7. DOI: https://doi.org/10.4103/ija.ija_300_21
44. Aziz MF, Berkow L. Pro-Con Debate: videolaryngoscopy should be standard of care for tracheal intubation. Anesth Analg. 2023;136(4):683-8. DOI: https://doi.org/10.1213/ANE.0000000000006252
45. D.Weingart S, Barnicle RN, Janke A, Bhagwan SD, Tanzi M, McKenna PJ, et al. A taxonomy of key performance errors for emergency intubation. Am J Emerg Med. 2023;73:137-44. DOI: https://doi.org/10.1016/j.ajem.2023.08.035
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