Systematic videolaryngoscopy use: remain aware of the risks

Abstract Background:Videolaryngoscopy is a life-saving technique recommended in difficult intubation algorithms in both the operating room and critical care settings. It has demonstrated numerous advantages in terms of increasing the success rate of first-attempt intubations. However, it is not without risks, notably in terms of injuries to the ENT area. These injuries and their incidence are very rarely described in the large trials promoting the routine use of videolaryngoscopy. This case-control study aims to highlight this risk in order to discuss the promotion of routine videolaryngoscopy use. Case report: A 52-year-old woman undergoes an inguinal hernia repair under coelioscopy. After two failed attempts of direct laryngoscopy, intubation using videolaryngoscopy is successfully performed on the first attempt. However, in the postoperative period, a lesion resembling a perforation of the anterior pillar of the right tonsillar fossa is discovered. The injury heals well after 10 days of monitoring. Discussion:Injuries to the ENT area following videolaryngoscopy are not uncommon and are even more frequent than after direct laryngoscopy. This can be explained by a false sense of security induced by a perfect view of the glottis on the screen, a pursuit of this perfect view even when it is not suitable for intubation with a glide scope, and the use of a too rigid stylet. Conclusion:It is advisable to exercise caution regarding the routine use of videolaryngoscopy until more substantial studies assessing this specific risk are conducted.