The Technology of Video Laryngoscopy

Lauren C. Berkow, MD; Timothy E. Morey, MD; Felipe Urdaneta, MD

Disclosures

Anesth Analg. 2018;126(5):1527-1534. 

In This Article

Abstract and Introduction

Abstract

Tracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms. However, it is quite possible that many airway managers do not have a thorough comprehension of how these devices actually function, an understanding that is vital not only for their use but also for assessing the devices' limitations. This article discusses the development of video laryngoscopy, how the video laryngoscope works, and the impact of video laryngoscopy on difficult airway management.

Introduction

Tracheal intubation via laryngeal exposure has evolved over the past 150 years and has greatly expanded in the last decade with the introduction and development of newer, more sophisticated optical airway devices. The introduction of indirect and video-assisted laryngoscopes has significantly impacted airway management as evidenced by the presence of these devices in the majority of published difficult airway algorithms.[1–3] However, it is quite possible that many airway managers do not have a thorough understanding of how these devices actually work, an understanding that is vital not only for their use but also for assessing the devices' limitations.

The original laryngoscopes, developed in the 19th century before the availability of electricity to consumers, used mirrors and sunlight to indirectly view the glottis (Figure 1). In the early 20th century, rigid direct laryngoscopes were introduced that could elevate the epiglottis and expose the larynx, allowing insertion of an endotracheal tube. The use of indirect techniques to visualize and instrument the larynx reemerged in the 1960s with the invention of the fiberoptic bronchoscope, followed by the launch of video technology in the early 2000s. The pendulum has shifted once again, and indirect viewing of the glottic opening has become popular in the last decade. This new technology has brought us back to the original concept of indirectly identifying the glottis, which now includes use of video monitors in addition to prisms.

Figure 1.

Image of the Boekel's laryngoscope, invented in 1886. An oil lamp was used as the light source. The operator looked through the hole in the mirror on the right into the larynx, which was illuminated by light being focused through the lens in the middle of the device. Source with permission: http://phisick.com/item/boekels-improved-laryngoscope/.

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