Dangers of Videolaryngoscopy-Assisted Intubation: Risk for Multiple Otolaryngologic Complications

Objectives: Discuss the management of upper airway injuries associated with videolaryngoscopy-assisted endotracheal intubation in a single tertiary care institution. Emphasize the need for thorough otolaryngologic evaluation, to include direct laryngoscopy, given the potential for multiple concurrent injuries. Methods: Case series and literature review. Results: Six intraoperative consults were requested of the otolaryngology service regarding traumatic videolaryngoscope-assisted intubations at a single tertiary care institution. 3/6 patients had elevated BMI, and 5/6 patients had an ASA score of 3. All patients sustained a right sided injury, and 4/6 presented with concurrent injuries at multiple sites. All injuries were immediately appreciated after intubation. While 3/6 patients with pharyngeal lacerations were able to be closed with primary closure, 3/6 required palatoplasty due to transpalatal intubation. Conclusion: Videolaryngoscopy has become an increasingly popular among anesthesia professionals for its ability to provide an improved view of the glottis without excessive anterior displacement of tongue and mandible. The reported incidence of videolaryngoscopy-related complications is 1%, the majority of which are minor. Significant palatal injuries are not uncommon and may require procedural intervention from an otolaryngologist. Transpalatal intubation creates a potential difficult-airway dilemma and may be treated with palatoplasty. Patients may present with multiple injuries to the aerodigestive tract, requiring thorough evaluation and procedural management. Proper training and direct visualization with insertion of the videolaryngoscope during intubation are essential. Otolaryngologists should be familiar with injury patterns seen in videolaryngoscope-assisted intubation trauma and strategies for treatment.