**Conflict of interest**

*Special Considerations in Human Airway Management*

aspiration of secretion may be effective.

with no long-term harm [69].

direct visualizations [72].

**6. Conclusion**

Fogging and secretions may obscure view, but they can be solved. Newer devices have additional antifogging adds and one should be aware about it during airway intubation. Adding oxygen may help in antifogging too, while successive early

The most frustrating situation is when the passage of tube may be difficult despite great view ("laryngoscopic paradox") [13, 24]. However, one must be aware of his/her understanding of the basic videolaryngoscopy concepts. Indeed, as the acute angle is often very sharp, an acutely angled stylet is necessary. In addition, depth perception is lost with a two-dimensional video image, and sometimes, operators may become fixated on the video screen and may not directly observe where the laryngoscope blade or endotracheal tube is being placed [24]. The consequences of this unawareness of the situation are injuries of soft tissues such as soft palate, tonsillar, or pharyngeal wall perforation [65–68]. According to one study female gender, right tonsillar pillars and soft palate were the most frequently injured [69]. The most common repair of these soft tissues' injuries was simple surgical closure

Additional limitations of videolaryngoscopy are as follows: the need of experience and the time demand for the operator to learn how to use them properly, the rapid deterioration of their display in the presence of a swelling or a secretion, and

There are few useful tips that can be practiced to avoid complications. It is particularly important to prepare the tube with the stylet to follow the angle of the blade. As a mnemonic aid, one can remember the abbreviation "CCLL": (1) Choose the right tube, (2) Check the endotracheal tube cuff, (3) Lubricate the stylet and the endotracheal tube (but spare the camera and the light source), and (4) Load the

To gain great maneuverability with the tube, it is advisable to hold the tube closer to its connector, not to be to too close with the view to the glottis (back it up), and in the case of difficulty, passing through the glottis to use the bougie [71]. In addition, some propose to view videolaryngoscopy as a four-step procedure: First step is to look in the mouth and insert the videolaryngoscopy blade under direct vision. The next step is to look at the screen while gently advancing with the blade toward epiglottis to get the best glottic view. The third step is to move the look again to the mouth while inserting the tube under the direct vision to avoid trauma of soft tissues. And finally, the fourth step, is again to look at the screen to complete intubation. This step will probably need extra rotations and angulations of the tube. It is important that the stylet removal and the tube adjustments are done under

Videolaryngoscopy can be used effectively in situations of expected and unexpected difficult airway management. There are several devices for videolaryngoscopy, which differ technically, but with a thorough knowledge of the technical specific details, the success of the use of different videolaryngoscopes in intubation is similar. The choice of a specific videolaryngoscope depends on the individual patient, local resources, and the expertise of the operator. The simplicity and benefits of using videolaryngoscopy lead enthusiasts to entitle videolaryngoscopy as the miracle solution for all possible situations where airway visualization and airway management is required. But, in clinical reality, videolaryngoscopy, like any airway management technique, has its advantages and disadvantages. Its great advantage is that even its shortcomings can be learned faster and more efficiently,

the fact that they are rather complicated and expensive devices [70].

stylet (i.e., band it according to the angle of videolaryngoscopy blade).

**240**

The author declares no conflict of interest.
