Summary of "Retire the Conventional Laryngoscope?"

Summary published February 25, 2023

Summary by Paul A. Lefebvre, JD

AANA Journal | February 2023

Bailey C, Dela Cruz R, Burns S, Austin PN. Retire the Conventional Laryngoscope? AANA J. 2023 Feb;91(1):39-45. PMID: 36722782.


  • In this article, the authors examined randomized controlled trials to compare success rates of video laryngoscopy (VL) and direct laryngoscopy (DL) to determine whether anesthesia professionals should primarily utilize video laryngoscopy to intubate all adult patients.
  • The study involved a comprehensive review of randomized controlled trials and systematic review sources found on PubMed and Cochrane Database of Systematic Reviews. The authors excluded sources examining neonatal and pediatric intubations, intubation of patients with cervical immobilization, intubation outside the operating room, and intubation performed by trainees from the study. 6 sources published between 2015 and 2020 met inclusion criteria.
  • The 6 sources were examined to measure intubation success rates based on 3 factors: first-pass intubation success, time-to-intubation, and oropharyngeal trauma. The study was limited by a lack of uniform methodology and measured outcomes across the 6 sources. Nevertheless, 5 out of 6 studies concluded success rates for the VL and DL groups were essentially the same.
  • There is insufficient evidence to suggest VL should replace DL for all adult intubations, though large clinical trials with uniform methodologies are needed to better evaluate outcomes of VL and DL intubations. In the interim, anesthesia professionals should rely on their clinical judgment and experience in determining the appropriate method of securing the airway when intubation is not expected to be difficult, and VL is recommended if the anesthesia professional has reason to suspect a difficult airway.