Redefining the Gold Standard of Advanced Airway Management: Use of A Dual Camera Input Screen to Facilitate Video laryngoscope-Assisted Fibreoptic intubating Videoendoscopic endotracheal Intubation

Failed or difficult intubation is associated with complications, including increased risk of hypertension, desaturation, unexpected admissions to the intensive care unit and death. Whilst direct laryngoscopy (DL) is by far the most common technique used to guide endotracheal intubation, the associated incidence of failure is high. Alternatives to DL use advanced technology to transmit an image from the tip of the scope to a display screen. Whilst videolaryngoscopy improves the view of the larynx during laryngoscopy; failure of endotracheal intubation with VL is also well documented. Thus, VL is not a panacea. However the combined use of a fibreoptic intubating videoendoscope (FIVE) and a VL eliminates the limitations of each individual device. Whilst the foresight, preparation, equipment and space required to implement this airway management strategy are usually prohibitive; I describe a technique that streamlines this approach. The C-MAC videolaryngoscope (with any blade) and a 11302 BDX FIVE (Karl Storz, Germany), within a clear plastic scope holder, if connected to a dual input 8403 ZX Screen (Karl Storz, Germany) attached to the 8401 YA stand (Karl Storz, Germany) is compact and portable. The combination of the improved visualization of the airway provided by the VL with the ability to use the FIVE as a tracheal tube introducer with a controllable tip greatly increases the range of airway challenges that can be overcome. This emerging technique could therefore redefine airway management

Key words: Videolaryngoscope; Endotracheal intubation; Direct laryngoscopy; Fibreoptic bronchoscope;Fibreopticintubating videoendoscope.