The development and preliminary evaluation of a proposed new scoring system for videolaryngoscopy

Clear documentation of anaesthetic technique, difficulties and complications is an essential part of good anaesthetic practice, particularly in the area of airway management. The current convention of describing intubation using a videolaryngoscope only in terms of a Cormack and Lehane score is at best unhelpful and at worst dangerous. In an attempt to address the inadequacy of a Cormack and Lehane score to describe videoscopic intubation, we propose a three part scoring system: view, ease and device - the 'Fremantle Score'. Preliminary evaluation of this system in a diverse group of anaesthetists utilising four available videolaryngoscopes in a simulated normal and difficult airway manikin has demonstrated that the system is easy to use, easy to understand and relevant. In three of the eight device and manikin combinations studied, the videolaryngoscopic view correlated with the ease of intubation. This highlights the need for an alternative tool to describe intubation with a videolaryngoscope. We consider this development of a specific videoscopic scoring system a first step in better describing intubation by a videolaryngoscope and improving patient care.