Direct versus indirect laryngoscopic visualization in human endotracheal intubation: A tool for virtual anesthesia practice and teleanesthesiology

Ben H. Boedeker, Benjamin W. Berg, Mary Bernhagen, W. Bosseau Murray

Research output: Chapter in Book/Report/Conference proceedingConference contribution

17 Scopus citations

Abstract

When performing the ABC's of care for the trauma patient, airway management is of paramount importance. Management of the airway is often difficult because medical personnel caring for the patient do not commonly intubate patients or manage airways. To accomplish endotracheal intubation, a direct line of sight must be accomplished through the mouth, pharynx and larynx to the glottic opening. This is anatomically challenging in patients with a small mouth, large tongue, lack of cervical mobility, cervical trauma, protruding incisors or small mandible. This investigation compares indirect laryngoscopy, which allows the laryngoscopist to "see around the corner" during intubation, to standard direct laryngoscopy. This indirect view is a virtual view of the airway accomplished by projecting the view from an image device on the end of the laryngoscope to a monitor viewed by the laryngoscopist. The virtual (indirect) laryngoscopy improved the view of the glottic opening by an average 1.28 (p<0.001) Cormack-Lehane grades, consistant with existing literature. Indirect laryngoscopy results in improved glottic visualization compared to direct laryngoscopy. This difference will prove critically important for medical personnel who infrequently intubate and for students learning intubation skills in a clinical setting. The results of our study confirm the value of videolaryngoscopy as a standard method for hands-on airway management training of medical personnel. Indirect "virtual" laryngoscopy is an advanced technology method which will advance the development of teleanesthesiology practice. Videolaryngoscopy is an enabling technology for development of remote telementoring of trainee intubation skills curricula using video enabled distributed learning systems. This research was conducted following an approved University of Nebraska Medical Center institutional review board protocol.

Original languageEnglish (US)
Title of host publicationMedicine Meets Virtual Reality 16 - Parallel, Combinatorial, Convergent
Subtitle of host publicationNextMed by Design, MMVR 2008
PublisherIOS Press
Pages31-36
Number of pages6
ISBN (Print)9781586038229
StatePublished - 2008
EventMedicine Meets Virtual Reality 16 - Parallel, Combinatorial, Convergent: NextMed by Design, MMVR 2008 - Long Beach, CA, United States
Duration: Jan 30 2008Feb 1 2008

Publication series

NameStudies in Health Technology and Informatics
Volume132
ISSN (Print)0926-9630
ISSN (Electronic)1879-8365

Conference

ConferenceMedicine Meets Virtual Reality 16 - Parallel, Combinatorial, Convergent: NextMed by Design, MMVR 2008
CountryUnited States
CityLong Beach, CA
Period1/30/082/1/08

Keywords

  • Airway management
  • Indirect laryngoscopy
  • Intubation
  • Teaching
  • Teleanesthesiology
  • Video laryngoscopy
  • Virtual image

ASJC Scopus subject areas

  • Biomedical Engineering
  • Health Informatics
  • Health Information Management

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