*4.1.1 Single lumen tube orotracheal intubation*

The primary use of videolaryngoscopy is the intubation guiding after the induction of general anesthesia in operation theaters, intensive care units, and emergency departments. Various specific pathologies that complicate intubation and represent possible situations of difficult airway management have been successfully overcome by using videolaryngoscopy.

Meta-analyses have shown that videolaryngoscopy compared with direct laryngoscopy reduces impossible intubations in expected difficult intubation in adults [27]. Among individual videolaryngoscopes, regardless of the subjective impressions of clinicians, there is no evidence that a single videolaryngoscope is better than others except specifically only the C-MAC Macintosh blade [27]. Evidence further suggests that videolaryngoscope versus direct laryngoscopy facilitates intubation, improves glottis visualization, and reduces the number of impossible glottis visualizations and reduces laryngeal airway trauma [27]. Cochran's 2016 systematic analysis did not prove that videolaryngoscopy reduces the number of intubation attempts. There were insufficient data to establish a temporal comparison of videolaryngoscopy and direct laryngoscopy of the impact of videolaryngoscopy on hypoxia and respiratory complications, the impact of obesity, and the impact of the site and circumstances of intubation (intensive care unit, emergency medicine) [27]. In children, in contrast to adults, the evidence shows that the number of intubation attempts using videolaryngoscopy is increased compared to direct laryngoscopy, the success of first attempt intubation is not increased, and moreover, the intubation time is extended [28, 29].

Although videolaryngoscopy improves visualization, evidence suggests that traditional direct laryngoscopy is a sufficiently successful method of airway management in intensive care units. Moreover, some evidence suggests that the number of complications when using videolaryngoscopy in intensive care units is higher, especially if used by inexperienced operators [30]. Therefore, for routine airway management in intensive care units, direct laryngoscopy is still recommended as first choice, but videolaryngoscopy is also recommended in a situation of unsuccessful direct laryngoscopy or in the case of expected difficult intubation in the hands of experts [31, 32]. There is a positive trend of using videolaryngoscopy in pediatric ICUs, particularly in older children and those with the positive history of difficult airway. However, there is still no demonstration that this trend has decreased the rate of severe tracheal intubation adverse events or lowered multiple attempts at endotracheal intubation [33].

#### *4.1.2 Double lumen tube orotracheal intubation*

Videolaryngoscopy can be used successfully for guiding a double lumen tube. Admittedly, according to some, it prolongs intubation time but improves visualization [34, 35].

## *4.1.3 Nasotracheal intubation*

Although videolaryngoscopy does not improve the overall success of intubation in nasotracheal intubation, it has been shown to improve the success of the first attempt and shorten the intubation time [36].

#### *4.1.4 Intubation of cervical spine pathology*

In a clinical scenario of immobilized cervical spine, specifically McGrath®, C-MAC® D- blade, and Airtraq® [37] increase intubation success [38].

#### *4.1.5 Awake intubation*

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].

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

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 SARS-CoV-2 [45].
