*4.1.7 Conduit for flexible fiberoptic bronchoscope [video-assisted flexible intubation (VAFI) techniques]*

The combined use of flexible bronchoscopy with rigid videolaryngoscopy benefits from the strengths of both techniques in normal and difficult airways. Although first associations were reported for specific videolaryngoscopes [46, 47], this concept seems to be independent of the specific brand or type of videolaryngoscope and flexible bronchoscope [48].

#### *4.1.8 Insertion of different devices into oropharynx*

Videolaryngoscopy can be particularly useful for guiding and correcting malposition of different devices through oropharynx such as nasogastric or orogastric tube [49], esophagoscopes, gastroscopes, or transesophageal echocardiography probe [50]. In addition, it can be useful when placing throat packs in oral and maxillofacial surgery. In thyroid surgery, it is useful for the visualization the proper placement of electromyographyic tube since the sensor mark on the tube should be placed exactly at the level of vocal cords [51, 52].

#### *4.1.9 Diagnosis and recording of upper airway pathology*

In addition to intubation, videolaryngoscopy has been shown to be successful for diagnostic and therapeutic surgical interventions in head and neck surgery. It has shown even superiority compared to videolaryngostroboscopy in diagnostic of different vocal pathologies [53]. Videolaryngoscopy can assist or replace traditional direct laryngoscopes for diagnostic of vocal pathology and small therapeutic

**239**

*Videolaryngoscopy, the Current Role in Airway Management*

**4.2 Educational and research usage of videolaryngoscopy**

procedures such as vocal polypectomies [54]. In addition, it can be used as an assistance device for small procedures involving the tongue base, such as biopsies, foreign body removal like coins, fish bones, etc., and radiofrequency treatment of obstructive sleep [55–57]. Using the C-MAC and a pair of Magill forceps, some authors reported to be able to successfully remove the duodenal stent dislodged in proximal esophagus [58]. Videolaryngoscopy, in combination with apnoic technique with spontaneous ventilation, was shown to be effective in pediatric cases for a safe, speedy, and successful removal of the foreign body with respect to an unprotected airway, wherein tracheal intubation was not a viable option [59].

Videolaryngoscopy is an excellent tool for teaching because it allows unhindered supervision of the intubation procedure [60]. In practice, it proves to be a particularly useful tool for introducing beginners to intubation procedures. Moreover, depending on the choice of blade and type of device, it allows the education of different advanced intubation techniques comparable to direct laryngoscopy, including a combination of different techniques [61]. The supervisor follows the procedure performed by the student in a real time with possibility to guide the student verbally or manually with prompt feedback of what has been done. To gain an expertise in situations of unexpected difficult airway, it is necessary to learn how to manage expected difficult airway during routine intubations. Evidence suggests that using videolaryngoscopy during intubation significantly helps in mastering the intubation technique by the trainees even in the most sensitive populations for

As a relatively new technique with plenty of new innovative devices, videolaryngoscopy is currently a fruitful subject for the researchers interested in airway management. However, as the indications for its use spread, videolaryngoscopy may be used as an auxiliary tool for the other static and dynamic researches that include

The possibility of recording the videolaryngoscopy procedure and subsequent reviewing of the recorded material offers the possibility of a thorough analysis of the procedure, which itself lasts a limited short time. The first such application was described in 1987 with the purpose of recording the vocal cords during vocal therapies [64]. Recorded material during videolaryngoscopy can be reproduced multiple times, which can be useful in subsequent analyzes that can be done for various medicolegal purposes (Video 1, Video 2, Video 3, and Video 4). It is especially useful to use archived images and videos as the part of preoperative preparation in patients for whom difficult intubation is expected. Another practical indication could be the examination of vocal cords after thyroid surgery and recording for medicolegal issues.

Despite the advantages and widespread use of videolaryngoscopy, there are some limitations that may be viewed as absolute or relative contraindications [13]. The only real absolute contraindication for videolaryngoscopy is the significant limitation of opening a mouth which does not allow to insert the blade. In this situation, retromolar intubation with videostylets or fiberoptic intubation, that are

*DOI: http://dx.doi.org/10.5772/intechopen.93490*

intubation such as newborns [62, 63].

visualization of oropharynx and the upper airway.

**5. Limitations and complications of videolaryngoscopy**

comparably smaller devices, may be a good alternative.

**4.3 Medicolegal usage of videolaryngoscopy**

*Special Considerations in Human Airway Management*

attempt and shorten the intubation time [36].

*4.1.4 Intubation of cervical spine pathology*

Although videolaryngoscopy does not improve the overall success of intubation in nasotracheal intubation, it has been shown to improve the success of the first

In a clinical scenario of immobilized cervical spine, specifically McGrath®,

Videolaryngoscopy is proving to be a successful alternative to fiberoptic bronchoscopy in awake intubation because it shortens intubation time, although intubation success and safety profile are indistinguishable [39, 40]. This benefit is recognized for bariatric patients [41, 42] and patients with cervical trauma [43].

Due to less direct contact of the operator with the generated aerosol during the intubation, videolaryngoscopy has been recommended in recent airway management algorithms for the patients with suspected or proven COVID-19 [44]. When this is feasible, it is preferred to use disposable blades and protective shields over the devices to avoid their contaminations and possible cross-transmission of the virus

C-MAC® D- blade, and Airtraq® [37] increase intubation success [38].

*4.1.6 Intubation of the patients with suspected or proven COVID-19*

*4.1.7 Conduit for flexible fiberoptic bronchoscope [video-assisted flexible* 

The combined use of flexible bronchoscopy with rigid videolaryngoscopy benefits from the strengths of both techniques in normal and difficult airways. Although first associations were reported for specific videolaryngoscopes [46, 47], this concept seems to be independent of the specific brand or type of videolaryngo-

Videolaryngoscopy can be particularly useful for guiding and correcting malposition of different devices through oropharynx such as nasogastric or orogastric tube [49], esophagoscopes, gastroscopes, or transesophageal echocardiography probe [50]. In addition, it can be useful when placing throat packs in oral and maxillofacial surgery. In thyroid surgery, it is useful for the visualization the proper placement of electromyographyic tube since the sensor mark on the tube should be

In addition to intubation, videolaryngoscopy has been shown to be successful for diagnostic and therapeutic surgical interventions in head and neck surgery. It has shown even superiority compared to videolaryngostroboscopy in diagnostic of different vocal pathologies [53]. Videolaryngoscopy can assist or replace traditional direct laryngoscopes for diagnostic of vocal pathology and small therapeutic

*4.1.3 Nasotracheal intubation*

*4.1.5 Awake intubation*

SARS-CoV-2 [45].

*intubation (VAFI) techniques]*

scope and flexible bronchoscope [48].

*4.1.8 Insertion of different devices into oropharynx*

placed exactly at the level of vocal cords [51, 52].

*4.1.9 Diagnosis and recording of upper airway pathology*

**238**

procedures such as vocal polypectomies [54]. In addition, it can be used as an assistance device for small procedures involving the tongue base, such as biopsies, foreign body removal like coins, fish bones, etc., and radiofrequency treatment of obstructive sleep [55–57]. Using the C-MAC and a pair of Magill forceps, some authors reported to be able to successfully remove the duodenal stent dislodged in proximal esophagus [58]. Videolaryngoscopy, in combination with apnoic technique with spontaneous ventilation, was shown to be effective in pediatric cases for a safe, speedy, and successful removal of the foreign body with respect to an unprotected airway, wherein tracheal intubation was not a viable option [59].
