Types of Video Laryngoscopes
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Video laryngoscopy has revolutionized airway management in medical practice, providing clinicians with enhanced visualization of the vocal cords and facilitating easier intubation, especially in difficult airway scenarios 1. Video laryngoscopes are equipped with a video camera and a light source that project real-time images onto a screen, allowing for better precision and increased success rates in intubation 2,3. Understanding the different types of video laryngoscopes and their applications enables anesthesiologists, intensivists, and emergency physicians to provide safe and effective care.
Non-channeled video laryngoscopes (such as GlideScope, C-MAC, or McGrath video laryngoscopes) feature a blade with an attached camera but no dedicated channel for the endotracheal tube. These types of video laryngoscopes provide a clear view of the larynx but require the clinician to manipulate the tube independently. They offer excellent visualization and are versatile in a wide range of intubation situations 4. Clinically, they allow for the use of different intubation techniques and can accommodate various endotracheal tube sizes and styles. However, these require excellent skill and coordination, which can be challenging for less experienced practitioners 4,5.
Channeled video laryngoscopes (such as Airtraq, Airwayscope, or King Vision video laryngoscopes) incorporate a guiding channel or track within the blade, designed to direct the endotracheal tube towards the glottic opening. This design simplifies the intubation process by providing a more controlled pathway for the tube. Some data have revealed faster intubation times and higher intubation success rates with channeled video laryngoscopes 4,5. The guiding channel helps maintain the correct trajectory of the endotracheal tube, reducing the risk of trauma and improving first-pass success rates. The disadvantage is that these may be less versatile than non-channeled video laryngoscopes, as the channel can restrict the use of certain intubation techniques or tube sizes. Additionally, the fixed pathway might limit maneuverability in extremely difficult airways 4,5.
A “hybrid” video laryngoscope design can enable greater flexibility for practitioners. The SensaScope video laryngoscope has a shaft made of rigid and flexible parts that can serve as a very versatile tool of great utility in the challenging intubation of anesthetized and/or paralyzed patients 6. Broadly, hybrid video laryngoscopes provide flexibility and versatility, accommodating various clinical scenarios and practitioner preferences. However, hybrid video laryngoscopes can be more complex and costly, and additional clinical testing is warranted 6.
The choice of video laryngoscope depends on several factors, including the clinician’s experience, the anticipated difficulty of the airway, and the clinical setting 7,8. Non-channeled video laryngoscopes are often preferred in complex airway cases, where direct manipulation of the tube is necessary or beneficial. Channeled video laryngoscopes are useful for routine intubations or for less experienced practitioners who benefit from the guiding channel, providing flexibility and adaptability in various situations.
Video laryngoscopy has significantly improved the safety and success of airway management. By understanding the different types of video laryngoscopes—non-channeled, channeled, and hybrid—clinicians can select the most appropriate tool for each intubation scenario to maximize patient outcomes across a variety of clinical scenarios.
References
1. Pieters, B. M., Eindhoven, G. B., Acott, C. & van Zundert, A. A. J. Pioneers of laryngoscopy: indirect, direct and video laryngoscopy. Anaesth. Intensive Care (2015). doi:10.1177/0310057x150430s103
2. Channa, A. Video laryngoscopes. Saudi Journal of Anaesthesia (2011). doi:10.4103/1658-354X.87262
3. Video laryngoscopy • LITFL Medical Blog • CCC Airway. Available at: https://litfl.com/video-laryngoscopy/. (Accessed: 2nd July 2024)
4. Biro, P. & Schlaepfer, M. Tracheal intubation with channeled vs. Non-channeled videolaryngoscope blades. Rom. J. Anaesth. Intensive Care (2018). doi:10.21454/rjaic.7518.252.sch
5. Chew, S. H., Lim, J. Z. M., Chin, B. Z. Bin, Chan, J. X. & Siew, R. C. H. Intubation with channeled versus non-channeled video laryngoscopes in simulated difficult airway by junior doctors in an out-of-hospital setting: A crossover manikin study. PLoS One (2019). doi:10.1371/journal.pone.0224017
6. Biro, P. The SensaScope® – A new hybrid video intubation stylet. Saudi Journal of Anaesthesia (2011). doi:10.4103/1658-354X.87271
7. Lee, J. et al. Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Journal of Personalized Medicine (2022). doi:10.3390/jpm12030363
8. Kim, Y. S., Song, J., Lim, B. G., Lee, I. O. & Won, Y. J. Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis. PLoS One (2020). doi:10.1371/journal.pone.0238060