Review of video laryngoscopy and rigid fiberoptic laryngoscopy

Recent advances in fiberoptic systems and video technology have resulted in the development of new intubation devices and techniques. A defining characteristic of rigid fiberoptic and videolaryngoscopic techniques is that glottic opening is viewed indirectly in place of direct line-of-sight. Various issues common to all instruments in this group are highlighted, and a few recently released tools are described. The aim of this article is to review material published since January 2007.

Indirect laryngoscopic techniques seemed to be easy to learn by both novice and experienced intubators, and can be used to teach both direct laryngoscopy and fiberoptic intubation. An adequate glottic view is generally easily obtained, which is frequently superior to that obtained by direct laryngoscopy. However, endotracheal tube insertion may be problematic, and various techniques have been developed to facilitate this procedure. Indirect laryngoscopic techniques are proving useful in situations of both anticipated and unanticipated difficult intubations, and therefore challenge the preeminence of flexible fiberoptic intubation.

As indirect laryngoscopic tools become more available, and clinicians become more facile in their use, the management of (potentially) difficult intubations is likely to change. Further technological advances are likely to lead to the development of even more new instruments.