A video-laryngoscope (VL) improves the view of the glottis compared to direct laryngoscopy. However, improved view does not always translate to successful intubation with a VL. What is the most common reason for this discrepancy?
- A VL produces more bleeding from the cords than direct laryngoscopy
- B VL images are two-dimensional and distort depth perception
- C The acute angle of the VL blade requires a pre-shaped stylet to navigate the ETT past the blade tip and around the sharp curve to the cords ✓
- D VL blades are thicker than Macintosh blades, causing more oropharyngeal obstruction
Correct answer: C. The acute angle of the VL blade requires a pre-shaped stylet to navigate the ETT past the blade tip and around the sharp curve to the cords
Explanation
Hyperangulated video-laryngoscope blades (e.g., GlideScope) provide excellent glottic views (Cormack-Lehane grade 1) even when the ETT cannot be manipulated to follow the same acute angle. Successful intubation requires a pre-shaped (hockey-stick, approximately 60°) stylet within the ETT to match the blade's curvature. Without this, the ETT hits the anterior tracheal wall or the cords despite the clear video view. Standard Macintosh-profile VLs with stylets are preferred when view is adequate; hyperangulated blades require specific technique.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.