[Anesthesia in High Definition - Standards for Endoscopic and Videolaryngoscopic Airway Management]

Airway management is a fundamental skill for anesthesiologists, particularly in the context of anticipated difficult airways. In such scenarios, current guidelines advocate for intubation under preserved spontaneous breathing - commonly referred to as awake intubation - as this approach minimizes the risk of upper airway collapse and ensures continuous ventilation.Flexible endoscopic intubation (FOI) has long been regarded as the gold standard for awake intubation. However, videolaryngoscopy (VL) is now firmly established in routine airway management, owing to its higher first-pass success rate and the growing familiarity among clinicians. As a result, VL is increasingly being used as a practical alternative to FOI in awake intubation, gradually displacing the latter in many institutions.This development presents both opportunities and challenges. While VL often enhances patient comfort and safety - especially in the hands of experienced users - it has also contributed to a decline in FOI proficiency. This is particularly concerning in cases where FOI remains indispensable, such as in patients with significantly restricted mouth opening or tumors of the oral or pharyngeal cavity. In such situations, the loss of routine FOI experience may compromise clinical outcomes.Future research and guideline development must acknowledge this evolving dynamic and seek to strike a balance between clinical efficiency, patient safety, and the preservation of core airway management competencies.