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Direct laryngoscopy or the direct laryngoscope (both referred to as DL) was introduced in 1895 by Alfred Kirstein. Physicians have since developed instruments to improve visualization of the larynx while limiting tissue trauma. The Macintosh and Miller laryngoscope blades were developed in the 1940s and have been the primary tool for endotracheal (ET) intubation.1 They have been effectively used for most ET intubations. There are limitations to their ability to allow direct visualization of the glottis and surrounding structures. Numerous adjuncts have been developed to assist in ET intubation.1

The development of video laryngoscopy or the video laryngoscope (both referred to as VL) marks a new era in airway management (Tables 20-1 and 20-2).2-4 Traditional DL requires alignment of the oral, pharyngeal, and laryngeal axes to visualize the glottis (Chapter 9). It is not always possible to align these three axes with mechanical manipulation. The major advantage of VL is that it does not require the Emergency Physician to align the three airway axes, reducing the need for manipulation and potential traumatic forces on the airway.5 VL provides a superior view of the glottis when compared to traditional DL. The eye of the VL camera is within centimeters of the glottis and provides a wider angle of vision than the 15° of traditional DL. The video monitor magnifies the view of the airway, making structures easier to visualize. The American Society of Anesthesiologists recommends having VL available as a tool for their Difficult Airway Algorithm.6 This chapter reviews a representative number of device types currently available and used in Emergency Departments (Table 20-3). A recent study reviews commonly used VLs (Table 20-4).7,8

TABLE 20-1The Advantages of Video Laryngoscopy
TABLE 20-2The Disadvantages of Video Laryngoscopy

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