Video and Mirror Laryngoscopes

Video and mirror laryngoscopes achieve endotracheal intubation by combining tongue retraction with a means of imaging the larynx from a supraglottic, hypopharyngeal perspective.

While secretions, blood, and vomitus may compromise the imaging method, most of these devices work reasonably well in these situations due to strategic placement of the imaging device on the blade (and often a protective lens). They have gained a great following in emergency airway management and are increasingly used in rapid sequence intubation, both in the hospital and the field.  They also are routinely chosen intubation technique in the morbidly obese and other patients with anticipated difficult airways.

Although the video screens in some of these devices are intended for daylight use, some field operators have found this problematic in very bright situations. A great advantage of these devices is noticeable in restricted space environments, i.e., helicopters, or intubating a trapped automobile passenger.  The imaging systems obviate the need for a supine patient position, and the imaging can adjust to accommodate different operator positions.

Laryngeal exposure with the various devices is usually straightforward.  The rigid curve of the tongue retractor is rotated about the tongue until the larynx comes into view.  All of these devices can theoretically be used as either with indirect epiglottis elevation (tip in the vallecula) or direct elevation (tip below epiglottis).  In many instances, however, tube delivery works best if the device is not inserted too far because this sometimes negative affects the insertion angle of the tube.

Each device has its own subtleties, especially when it comes to tube insertion and intubation.

Click on each device listed in the menu at left for more information.