Videolaryngoscopy vs. direct laryngoscopy use by experienced anaesthetists in patients with known difficult airways: a systematic review and meta-analysis

Experienced anaesthetists can be confronted with difficult or failed tracheal intubations. We performed a systematic review and meta-analysis to ascertain if the literature indicated if videolaryngoscopy conferred an advantage when used by experienced anaesthetists managing patients with a known difficult airway. We searched PubMed, MEDLINE, Embase and the Cochrane central register of controlled trials up to 1 January 2017. Outcome parameters extracted from studies were: first-attempt success of tracheal intubation; time to successful intubation; number of intubation attempts; Cormack and Lehane grade; use of airway adjuncts (e.g. stylet, gum elastic bougie); and complications (e.g. mucosal and dental trauma). Nine studies, including 1329 patients, fulfilled the inclusion criteria. First-attempt success was greater for all videolaryngoscopes (OR 0.34 (95%CI 0.18–0.66); p = 0.001). Use of videolaryngoscopy was associated with a significantly better view of the glottis (Cormack and Lehane grades 1 and 2 vs. 3–4, OR 0.04 (95%CI 0.01–0.15); p < 0.00001). Mucosal trauma occurred less with the use of videolaryngoscopy (OR 0.16 (95%CI 0.04–0.75); p = 0.02). Videolaryngoscopy has added value for the experienced anaesthetist, improving first-time success, the view of the glottis and reducing mucosal trauma.