Will Video Laryngoscopy become the norm?

[u/Radiant_Alchemist]

I love VL. They make standard laryngoscopes look brutal. They're less traumatizing, they give a better view, they have a better first-pass success. Sure you need to learn direct laryngoscopy but let's say in 5 years from now will they be used as routine in OR and ER intubations? Or will they be saved for hard cases?

I've been told that the equipment tends to suck and that we won't have VL as available as in the current department that I'm working so I should stick to Macintosh and McCoy.

[u/Crunchygranolabro]

VL was preferred for first pass during my residency, and continues to be what most everyone (including the crusty old guys) reach for as our first pass in the community. So in short: I feel like VL is already the norm.

In residency the preference was that we used the video mac to VL, while the attending watched the screen. In practice, plastic doesn’t have the same power that metal does when it comes to lifting tissue, so it made it a bit harder.

As more people are obese with fat necks and extra jowls…hyperangulated is just too effective.

[u/MarginalLlama → u/Crunchygranolabro]

Respectfully, how much tissue are we ortho-broing with a VL? Even in short-neck obese patients, positioning the VL well and a little BURP has worked well without needing to do any significant tissue displacement with the VL blade. I guess I'm just curious if there is something I'm missing or could learn?

[u/Crunchygranolabro → u/MarginalLlama]

Video gets a great view on the screen. And those of us of the younger video game generations are pretty facile with hand-screen coordination.

You hit the nail on the head, that it’s about technique and preparation or lack thereof.

Specifically using a plastic mac3-4 blade to get a direct view can be less forgiving of sloppy technique. You need good positioning, really good tongue sweep, etc. Whereas a metal blade provides an easier tongue sweep and with a bit of muscle can lift the laryngeal anatomy, along with the whole head to make up for bad positioning.

My general approach is to use a video mac 3-4 for a DL look, plus/minus a bougie more to keep in practice and reinforce good technique for most “simple” airways, knowing that if needed I can always look up at the screen. I use the hyperangulated blade for the physiologically scary, or anatomically difficult tubes where I want to be as smooth and fast as possible, because that’s the device I’m most comfortable with.

[u/MarginalLlama → u/Crunchygranolabro]

Thank you for the clarification and detail!

The plastic vs metal piece makes sense to me now, and I'll have to consider using the video mac blades for a direct look in the future.