To the Editor:--Teaching direct laryngoscopy to the novice may be associated with anxiety for both instructor and student. This can be attributed partly to the fact that the instructor cannot see what the laryngoscopist is (or is not) visualizing during the procedure. In an effort to solve this problem, we used a newly developed direct laryngoscopy video system, the Airway Cam (Airway Cam Technologies, New York, NY), which may be purchased from the manufacturer for approximately $6,000. The system consists of a headframe-mounted miniature camera (11-mm lens with 90 degrees prism) connected to a video monitor. The frame is placed on the head, and the camera is adjusted until it is adjacent to the laryngoscopist's dominant eye (direct laryngoscopy is a monocular procedure; Figure 1). In this position, the camera allows the instructor and the student to view the entire laryngoscopy procedure, from insertion of the laryngoscope to placement of the endotracheal tube. Importantly, the instructor can assist with proper landmark identification and visually confirm successful tracheal intubation (Figure 2). The educational benefit may be enhanced if a standard videocassette recording of the procedure is reviewed later to highlight critical technical points.
Figure 1. The direct laryngoscopy video system (Airway Cam, Airway Cam Technologies, New York, NY) as it is worn by the laryngoscopist. The camera's position is just medial to the dominant eye. The camera also may be used in the lateral position.
Figure 1. The direct laryngoscopy video system (Airway Cam, Airway Cam Technologies, New York, NY) as it is worn by the laryngoscopist. The camera's position is just medial to the dominant eye. The camera also may be used in the lateral position.
Figure 2. Typical image achieved during direct laryngoscopy, which allows the instructor to assist in the identification of important anatomic structures and suggest maneuvers to achieve optimal visualization.
Figure 2. Typical image achieved during direct laryngoscopy, which allows the instructor to assist in the identification of important anatomic structures and suggest maneuvers to achieve optimal visualization.
Other video systems assist with direct laryngoscopy instruction. Most incorporate a fiberoptic bronchoscope into the laryngoscope, which often achieves excellent glottic views. [1]These views do not always correlate well with the view of the laryngoscopist, who must contend with the visual limitations imposed by oropharyngeal structures, avoided by the fiberoptic bronchoscope because of its location near the end of the laryngoscope blade. In contrast, the head-mounted camera system provides a complete view from the perspective of the laryngoscopist, including essential oropharyngeal elements.
Michael S. Higgins, MD, Assistant Professor of Anesthesiology
Jayant K. Deshphande, M.D, Associate Professor of Pediatrics and Anesthesiology
Ahmed Badr, MD, Senior Resident, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232
The authors have no financial affiliation with Airway Cam Technologies, Inc., relating to sales or use of their direct laryngoscopy video system.
