In the new Difficult Airway Management issue of Anesthesiology News, three Sheridan physician leaders who are also prominent anesthesiologists discuss the inexorable shift from fiberoptic intubation and direct laryngoscopy toward video laryngoscopy and how that trend is shaping the future of patient care and the practice of anesthesiology.
Sheridan’s Regional Medical Director Dr. Joseph Loskove, Chief Quality Officer Dr. Gerald Maccioli and National Education Director, Anesthesiology Division Dr. Adam Blomberg say that, although direct fiberoptic intubation has widely been considered a gold standard for anticipated difficult-to-intubate (DTI) patients, a lack of consensus among national anesthesia societies on what constitutes best practice in specific situations brings into question whether a universally applicable gold standard for difficult airway management can, or should, exist.
This lack of agreement on clinical best practices makes the inherently difficult job of intubating DTI patients even harder. Further complicating clinical decisions about difficult airway management practices is that as video laryngoscopy becomes the primarily modality of choice, clinicians who intubate patients only occasionally or who have less experience with fiberoptic intubation and direct laryngoscopy become less comfortable using them.
Drs. Loskove, Maccioli and Blomberg emphasize the need to provide anesthesiologists and other clinicians who might need to intubate DTI patients with better and more consistent guidance that helps them make good judgment calls about the optimal modality for a specific application or case, as well as more helpful guidance on when it might be advisable to change to an alternative modality in the event of complications. The authors also stress the importance of helping anesthesiologists maintain or develop their level of comfort using conventional laryngoscopes, so that they maintain a complete and comprehensive set of laryngoscopy modalities in their DTI tool kits and are comfortable switching from video laryngoscopy to fiberoptic intubation or direct laryngoscopy if the technology fails them.
The article concludes with a discussion of the importance of optimizing and implementing system-wide protocols, such as the extremely successful difficult-to-intubate protocol that Dr. Loskove installed throughout the Memorial Healthcare System (MHS).
Read more about the perspectives of these renowned anesthesiologists and physician leaders in their Anesthesiology News article, The Shift Toward Video Laryngoscopy: The Good, the Bad, and the Future.