Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice

  • Cristian Camilo Becerra Gómez Anesthesia and Perioperative Medicine, Fundación Universitaria Sanitas. Bogotá, Colombia.
  • Miguel Ángel Rojas Department of Anesthesia and Perioperative Medicine, Clínica Reina Sofía. Bogotá, Colombia.
Keywords: Videolaryngoscopy, Laryngoscopy, Airway management, Critical care, Intratracheal intubation, Anesthesiology


During the past two decades, the videolaryngoscope (VDL) has become a valuable and effective tool for the management of the airway, not just in the realm of anesthesiology, but also in other medical specialties in clinical scenarios requiring tracheal intubation.  In countries such as the United States, this represents over 15 million cases in the operating room and 650,000 outside the OR.  The overall accumulated incidence of difficult airway is 6.8% events in routine practice and between 0.1 and 0.3 % of failed intubations, both associated with complications such as desaturation, airway injury, hemodynamic instability and death. Notwithstanding the fact that the VDL has proven advantages such as improved visualization of the glottis, higher first attempt success rates, and a shortened learning curve, most of the time its use is limited to rescue attempts or as a secondary option.  The objective of this article is to review the advantages and limitations of the VDL vs. the direct laryngoscope in a wide range of clinical settings, including the operating room, intensive care units, emergency departments, pediatrics, obstetrics, and Covid-19 to consider its routine use.


Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31. doi:

Cooper RM. Use of a new videolaryngoscope (GlideScope®) inthe management of a difficult airway. Can J Anaesth. 2003;50(6):611-3. doi:

Paolini J-B, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth. 2013;60(2):184-91. doi:

Lundstrøm LH, Vester-Andersen M, Møller AM, Charuluxananan S, L’hermite J, Wetterslev J, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011;107(5):659-67. doi:

Chemsian R, Bhananker S, Ramaiah R. Videolaryngoscopy. Int J Crit Illn Inj Sci. 2014;4(1):35-41. doi:

Liu D-X, Ye Y, Zhu Y-H, Li J, He H-Y, Dong L, et al. Intubation of non-difficult airways using video laryngoscope versus direct laryngoscope: a randomized, parallel-group study. BMC Anesthesiol. 2019;19(1):75. doi:

Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31-81. doi:

Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth. 2009;102(4):546-50. doi:

Serocki G, Bein B, Scholz J, Dörges V. Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope. Eur J Anaesthesiol. 2010;27(1):24-30. doi:

Rosenblatt WH, Yanez ND. A decision tree approach to airway management pathways in the 2022 difficult airway algorithm of the American Society of Anesthesiologists. Anesth Analg. 2022;134(5):910-5. doi:

Kramer A, Müller D, Pförtner R, Mohr C, Groeben H. Fibreoptic vs videolaryngoscopic (C-MAC(®) D-BLADE) nasal awake intubation under local anaesthesia. Anaesthesia. 2015;70(4):400-6. doi:

Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta-analysis. Anaesthesia. 2018;73(9):1151-61. doi:

Griesdale DEG, Liu D, McKinney J, Choi PT. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anaesth. 2012;59(1):41-52. doi:

Sajayan A, Nair A, McNarry AF, Mir F, Ahmad I, El-Boghdadly K. Analysis of a national difficult airway database. Anaesthesia. 2022;77(10):1081-8. doi:

Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. 2015;70(3):272-81. doi:

Aziz MF, Brambrink AM, Healy DW, Willett AW, Shanks A, Tremper T, et al. Success of intubation rescue techniques after failed direct laryngoscopy in adults: A retrospective comparative analysis from the multicenter perioperative outcomes group. Anesthesiology. 2016;125(4):656-66. doi:

Sakles JC, Mosier JM, Patanwala AE, Dicken JM, Kalin L, Javedani PP. The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. J Emerg Med. 2015;48(3):280-6. doi:

Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The physiologically difficult airway. West J Emerg Med. 2015;16(7):1109-17. doi:

Griesdale DEG, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34(10):1835-42. doi:

O’Gara B, Brown S, Talmor D. Video laryngoscopy in the intensive care unit. Seeing is believing, but that does not mean it´s true. JAMA. 2017;317(5):479. doi:

Jaber S, De Jong A, Pelosi P, Cabrini L, Reignier J, Lascarrou JB. Videolaryngoscopy in critically ill patients. Crit Care. 2019;23(1):221. doi:

De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40(5):629-39. doi:

Arulkumaran N, Lowe J, Ions R, Mendoza M, Bennett V, Dunser MW. Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis. Br J Anaesth. 2018;120(4):712-24. doi: 10.1016/j.bja.2017.12.041

Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E, et al. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: A randomized clinical trial. JAMA. 2017;317(5):483-93. doi:

Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120(2):323-52. doi:

Quintard H, l’Her E, Pottecher J, Adnet F, Constantin J-M, Dejong A, et al. Intubation et extubation du patient de réanimation. Anesthésie & Réanimation. 2018;4(6):523-47. doi:

De Jong A, Molinari N, Terzi N, Mongardon N, Arnal J-M, Guitton C, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187(8):832-9. doi:

De Jong A, Myatra SN, Roca O, Jaber S. How to improve intubation in the intensive care unit. Update on knowledge and devices. Intensive Care Med. 2022;48(10):1287-98. doi:

Adewale L. Anatomy and assessment of the pediatric airway. Paediatr Anaesth. 2009;19(Suppl 1):1-8. doi:

Fiadjoe JE, Nishisaki A, Jagannathan N, Hunyady AI, Greenberg RS, Reynolds PI, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016;4(1):37-48. doi:

Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014;24(10):1056-65. doi:

Miller KA, Nagler J. Advances in emergent airway management in pediatrics. Emerg Med Clin North Am. 2019;37(3):473-91. doi:

Balaban O, Tobias JD. Videolaryngoscopy in neonates, infants, and children. Pediatr Crit Care Med. 2017;18(5):477-85. doi:

Xue F-S, Liu Y-Y, Li H-X, Yang G-Z. Paediatric video laryngoscopy and airway management: What’s the clinical evidence? Anaesth Crit Care Pain Med. 2018;37(5):459-66. doi:

Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, Swales H, Quinn AC, et al. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth. 2015;24(4):356-74. doi:

Bordoni L, Parsons K, Rucklidge MWM. Obstetric airway management. World Federation of Societies of Anaesthesiologists: Update in Anesthesia. 2019;34:7-13. doi:

Lucas DN, Vaughan DJA. Videolaryngoscopy and obstetric anaesthesia. Br J Anaesth. 2017;119(3):549. doi:

Ångerman S, Kirves H, Nurmi J. A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation. Anaesthesia. 2018;73(3):348-55. doi:

Howle R, Onwochei D, Harrison S-L, Desai N. Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis. Can J Anaesth. 2021;68(4):546-65. doi:

April MD, Arana A, Reynolds JC, Carlson JN, Davis WT, Schauer SG, et al. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 2021;162:403-11. doi:

Butler K, Winters M. The physiologically difficult intubation. Emerg Med Clin North Am. 2022;40(3):615-27. doi:

Lentz S, Grossman A, Koyfman A, Long B. High-Risk airway management in the emergency department. Part I: Diseases and approaches. J Emerg Med. 2020;59(1):84-95. doi:

Brown CA, Bair AE, Pallin DJ, Walls RM. NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med. 2015;65(4):363-70.e1. doi:

Sakles JC, Mosier J, Chiu S, Cosentino M, Kalin L. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012;60(6):739-48. doi:

Sakles JC, Javedani PP, Chase E, Garst-Orozco J, Guillén-Rodríguez JM, Stolz U. The use of a video laryngoscope by emergency medicine residents is associated with a reduction in esophageal intubations in the emergency department. Acad Emerg Med. 2015;22(6):700-7. doi:

Brown CA, Kaji AH, Fantegrossi A, Carlson JN, April MD, Kilgo RW, et al. Video laryngoscopy compared to augmented direct laryngoscopy in adult emergency department tracheal intubations: A national emergency airway registry (NEAR) study. Acad Emerg Med. 2020;27(2):100-8. doi:

Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. 2020;75(6):785-99. doi:

Granell M, Sanchis N, Delgado C, Lozano M, Pinho M, Sandoval C, et al. Airway management of patients with suspected or confirmed covid-19: Survey results from physicians from 19 countries in Latin America. J Clin Med. 2022;11(16). doi:

Ahmad I, Jeyarajah J, Nair G, Ragbourne SC, Vowles B, Wong DJN, et al. A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams. Can J Anaesth. 2021;68(2):196-203. doi:

Davies M, Hodzovic I. Videolaryngoscopy post COVID-19. Trends in Anaesthesia and Critical Care. 2021;36:49-51. doi:

Armstrong L, Harding F, Critchley J, McNarry AF, Myatra SN, Cooper R, et al. An international survey of airway management education in 61 countries. Br J Anaesth. 2020;125(1):e54-60. doi:

Hamal PK, Chaurasia RB, Pokhrel N, Pandey D, Shrestha GS. An affordable videolaryngoscope for use during the COVID-19 pandemic. Lancet Glob Health. 2020;8(7):e893-4. doi:

Kamdi R, Panigrahi B, Saxena R. Video Laryngoscopes-Market Analysis (2016 - 2028). Base Year - 2020. Grand View Research. Inc, USA.; 2021. Available at

Hamal PK, Yadav RK, Malla P. Performance of custom made videolaryngoscope for endotracheal intubation: A systematic review. PLoS ONE. 2022;17(1):e0261863. doi:

Saoraya J, Musikatavorn K, Sereeyotin J. Low-cost videolaryngoscope in response to covid-19 pandemic. West J Emerg Med. 2020;21(4):817-8. doi:

Slinn SJ, Froom SR, Stacey MRW, Gildersleve CD. Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective? Paediatr Anaesth. 2015;25(1):20-6. doi:

Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022;4:CD011136. doi:

Gupta A, Sharma R, Gupta N. Evolution of videolaryngoscopy in pediatric population. J Anaesthesiol Clin Pharmacol. 2021;37(1):14-27. doi:

Cook TM, Aziz MF. Has the time really come for universal videolaryngoscopy? Br J Anaesth. 2022;129(4):474-7. doi:

Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827-48. doi:

How to Cite
Becerra Gómez CC, Ángel Rojas M. Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice. Colomb. J. Anesthesiol. [Internet]. 2023 Aug. 24 [cited 2024 Jun. 15];52(1). Available from:


Download data is not yet available.
How to Cite
Becerra Gómez CC, Ángel Rojas M. Should videolaryngoscopy be routinely used for airway management? An approach from different scenarios in medical practice. Colomb. J. Anesthesiol. [Internet]. 2023 Aug. 24 [cited 2024 Jun. 15];52(1). Available from:
Narrative review


Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: