Video kills the flexible fibreoptic star

Hi. I found this interesting abstract on the ASA website. Click on the title for full abstract with figures. A few studies this year have shown utility of awake VL intubation vs traditional awake flexible fibreoptic intubation.

Impact of Video Laryngoscopy in a Large Tertiary Anesthesia Practice

Lawrence R. Bellmore, M.D., Daniel A. Diedrich, M.D., Daniel R. Brown, M.D.,Ph.D., Laurence C. Torsher, M.D., Arun Subramanian, M.B.,B.S.
Mayo Clinic, Rochester, Minnesota, United States

Fiberoptic Bronchoscopic Intubation (FOI) has been considered the gold standard for safely securing a “difficult airway.”The advent of video laryngoscopes (VL) provides an additional technique to manage potentially difficult airways. This study looks at the trends in airway management techniques, including the impact on FOI, before and after the introduction of VL.

METHODS The Mayo Clinic Anesthesia Data Mart contains a comprehensive list of anesthesia related variables. Following IRB approval, this database was queried for all airway procedures by anesthesia providers from 07/01/2007 to 12/31/2011. Only adult patients undergoing airway instrumentation were included. Data on date, type of surgery, ASA status, mask ventilation grade, direct laryngoscopy grade and airway management technique were collected. The trends in airway techniques as a percentage of total airway procedures were calculated. To assess the impact of the introduction of VL on the FOI, a pre-VL group (07-09/2007) and a post-VL group (07-09/2011) were identified and compared. Chi-square test was used to compare each airway technique between the two groups.


Over the five year period, airway procedures increased by 7.9% while the total number of general anesthetics increased by 10.7%. The frequency of DL and FOI decreased while that of VL and laryngeal mask airways (LMA) increased . Compared to the pre-VL group, there was a significant decrease in the number of FOIs in the post-VL group


The introduction of video laryngoscopes has resulted in a decrease in the frequency of fiberoptic intubations. The implication of this finding for trainee education, time to secure the airway which impacts operating room utilization and patient satisfaction needs further exploration.

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