[Pros/Cons: Airway Management for Separate-side Ventilation: Always Use a Video Laryngoscope?]

Area of Science:

• Anesthesiology
• Airway Management
• Thoracic Anesthesia

Background:

• Optimal airway management for double-lumen tube (DLT) intubation in thoracic anesthesia is debated.
• Video laryngoscopy (VL) use with DLTs is controversial, despite its routine application with single-lumen tubes.

Purpose of the Study:

• To compare video laryngoscopy (VL) versus direct laryngoscopy (DL) for routine DLT intubation in thoracic anesthesia.
• To critically evaluate current evidence and inform clinical decision-making regarding the standard of care.

Main Methods:

• Analysis presented in a debate format, reviewing randomized trials, meta-analyses, and observational studies.
• Comparison of VL and DL based on glottic visualization, intubation success rates, trauma, and DLT misplacement.

Main Results:

• VL may offer improved glottic view, first-attempt success, and reduced trauma, particularly with Macintosh blades.
• DL can be faster and more reliable in routine settings, while VL has limitations like longer intubation times and potential DLT passage difficulty.
• VL shows advantages in difficult airways, but DL may be superior for routine DLT intubation.

Conclusions:

• VL offers benefits in specific scenarios, but DL remains a viable and potentially faster option for routine DLT intubation.
• Evidence suggests DL may provide more reliable outcomes in routine thoracic anesthesia compared to VL.
• Informed clinical decisions require careful consideration of VL and DL advantages/disadvantages for DLT intubation.