patients with a limited mouth opening, but you'd run into the same
issue with direct laryngoscopy. Performing an awake fiber-optic intu-
bation through the mouth or nose is a viable option in those circum-
stances, and a skill that would still be important for providers to mas-
ter. In my mind, anesthetists should perform video laryngoscopy for
every case and have the ability to rely on fiber-optic intubations to
manage difficult airways. I get the sense that some providers are the
only ones who are pushing back against that idea.
Safety pioneers
Current guidelines call for the use of video laryngoscopes only when
direct laryngoscopy has been attempted and failed. Although the over-
all use of the devices is unknown, the generally accepted 6% rate of
difficult intubations provides some indication of how often anes-
thetists might opt for the technology to secure the airway.
If that ballpark figure is accurate, the rate must increase. Anesthesia
care revolves around technology. Providers have long been interested
in new devices that make patient care safer. Now's the time to take
another big step forward to enhance airway management during the
most crucial and dangerous moments of general anesthesia delivery.
It's time for anesthesia providers to be pioneers in patient safety and
incorporate video laryngoscopy into their daily practice. Intubation is
the most dangerous aspect of delivering general anesthesia, and fail-
ing to do it successfully puts patients' lives in danger. Why wouldn't
anesthesia providers use a tool that makes securing the airway easier
and safer? OSM
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M A Y 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Dr. Hemmerling (thomas.hemmerling@mcgill.ca) is an associate professor in the department of
anesthesiology at McGill University and director of anesthesiology at Hôpital Fleury in Montreal,
Canada.
