A national survey of videolaryngoscopes and alternative intubation devices in Hungary

Autoři: Bálint Nagy aff001;  Szilárd Rendeki aff001
Působiště autorů: Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary aff001;  Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary aff002;  Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223645



Videolaryngoscopy (VL) as a new airway management technique has evolved in recent decades, and a large number of videolaryngoscopes are now available on the market. Most recent major guidelines already recommend the immediate availability and use of VL in difficult airway management scenarios. However, national data on the availability of VL, introduction into practice and patterns of use are rarely published. Therefore, the current study aimed to provide data on VL in Hungary.

Materials and methods

An electronic survey was designed and popularized with the help of the Hungarian Society of Anaesthesiology and Intensive Therapy to explore the availability, use, and practice of and attitudes toward VL among Hungarian anesthesiologists. The survey was conducted between 01.01.2018 and 31.12.2018.


In total, 324 duly completed forms were returned and analyzed. Responders were mainly males (58%), specialists (80%) and those involved mainly in anesthesia practice (68%) in the public sector. Two hundred and ten (65%) responders had access to various videolaryngoscopes and were mainly from surgery, intensive care and traumatology units. No responders reported the availability of eight videolaryngoscopes out of the eighteen listed devices, and 32% of the responders had never used any videolaryngoscope in clinical settings. The most commonly available devices were KingVision, MacGrath Mac and Airtraq. Most of the responders reported using videolaryngoscopes mainly for difficult airway management and reported using a fiberscope as the first alternative device. Popular methods for selecting videolaryngoscopes included the following: short clinical trial (n = 67/324), decision of the departmental lead (n = 65/324) and price (n = 54/324). The majority of responders had some training prior to clinical application, but training was mainly voluntary. Overall, 98% of the responders considered videolaryngoscopes beneficial.


Approximately two-thirds of Hungarian anesthesiologists have immediate access to videolaryngoscopes, which are used mainly for difficult airway management. The overall attitude towards VL is positive, and many videolaryngoscopes are known and have been used by Hungarian anesthesiologists. However, only a few devices on the market are used commonly. Based on the results, further improvement might be recommended regarding VL training and availability.

Klíčová slova:

Anesthesia – Anesthesiology – Hungary – Intensive care units – Intubation – Medical devices and equipment – Ophthalmology – Trauma surgery


1. Rendeki S, Keresztes D, Woth G, Mérei Á, Rozanovic M, Rendeki M, et al. Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices. BMC Anesthesiol. 2017;17: 68. doi: 10.1186/s12871-017-0362-y 28549421

2. Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017;119: 369–83. doi: 10.1093/bja/aex228 28969318

3. Aziz MF, Brambrink AM, Healy DW, Willett AW, Shanks A, Tremper T, et al. Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults. Anesthesiology. 2016;125: 656–66. doi: 10.1097/ALN.0000000000001267 27483124

4. Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia. 2008;63: 745–60. doi: 10.1111/j.1365-2044.2008.05489.x 18582261

5. Zaouter C, Calderon J, Hemmerling TM. Videolaryngoscopy as a new standard of care. Br J Anaesth. 2015;114: 181–3. doi: 10.1093/bja/aeu266 25150988

6. Sakles JC, Mosier JM, Patanwala AE, Arcaris B, Dicken JM. The Utility of the C-MAC as a Direct Laryngoscope for Intubation in the Emergency Department. J Emerg Med. 2016;51: 349–57. doi: 10.1016/j.jemermed.2016.05.039 27471132

7. De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40: 629–39. doi: 10.1007/s00134-014-3236-5 24556912

8. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115: 827–48. doi: 10.1093/bja/aev371 26556848

9. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2013;118: 251–70. doi: 10.1097/ALN.0b013e31827773b2 23364566

10. Frova G, Sorbello M. Algorithms for difficult airway management: a review. Minerva Anestesiol. 2009;75: 201–9. 18946426

11. Cook TM, Kelly FE. A national survey of videolaryngoscopy in the United Kingdom. Br J Anaesth. 2017;118: 593–600. doi: 10.1093/bja/aex052 28403414

12. Woodall NM, Cook TM. National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists. Br J Anaesth. 2011;106: 266–71. doi: 10.1093/bja/aeq339 21131655

13. Gill RL, Jeffrey ASY, McNarry AF, Liew GHC. The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys. Anesthesiol Res Pract. 2015:152014. doi: 10.1155/2015/152014 25628653

14. Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth. 2011;106: 617–31. doi: 10.1093/bja/aer058 21447488

15. Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106: 632–42. doi: 10.1093/bja/aer059 21447489

16. Porhomayon J, El-Solh AA, Nader ND. National survey to assess the content and availability of difficult-airway carts in critical-care units in the United States. J Anesth. 2010;24: 811–14. doi: 10.1007/s00540-010-0996-0 20694482

17. Heinrich S, Birkholz T, Irouschek A, Ackermann A, Schmidt J. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia. J Anesth. 2013;27: 815–21. doi: 10.1007/s00540-013-1650-4 23748552

18. Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Pediatr Anesth. 2014;24: 1056–65.

19. Mathew PJ. Videolaryngoscopy-is there a role in paediatric airway management? Minerva Anestesiol. 2013;79: 1326–8. 24107837

20. Zaouter C, Calderon J, Hemmerling TM. Videolaryngoscopy as a new standard of care. Br J Anaesth. 2015;114: 181–3. doi: 10.1093/bja/aeu266 25150988

21. Paolini J-B, Donati F, Drolet P. Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anesth 2013;60: 184–91. doi: 10.1007/s12630-012-9859-5 23233395

22. Healy DW, Maties O, Hovord D, Kheterpal S. A systematic review of the role of videolaryngoscopy in successful orotracheal intubation. BMC Anesthesiol. 2012;12:32. doi: 10.1186/1471-2253-12-32 23241277

23. Sgalambro F, Sorbello M. Videolaryngoscopy and the search for the Holy Grail. Br J Anaesth. 2017;118: 471–2. doi: 10.1093/bja/aex022 28203746

24. Sorbello M, Afshari A, De Hert S. Device or target? A paradigm shift in airway management: Implications for guidelines, clinical practice and teaching. Eur J Anaesthesiol. 2018;35: 811–4. doi: 10.1097/EJA.0000000000000893 30278031

25. Pott LM, Randel GI, Straker T, Becker KD, Cooper RM. A survey of airway training among U.S. and Canadian Anesthesiology residency programs. J Clin Anesth. 2011;23: 15–26. doi: 10.1016/j.jclinane.2010.06.009 21296243

26. Di Marco P, Scattoni L, Spinoglio A, Luzi M, Canneti A, Pietropaoli P, et al. Learning Curves of the Airtraq and the Macintosh Laryngoscopes for Tracheal Intubation by Novice Laryngoscopists. Anesth Analg. 2011;112: 122–5. doi: 10.1213/ANE.0b013e3182005ef0 21048093

Článek vyšel v časopise


2019 Číslo 10