Seeing is not enough: why introducer choice matters in hyperangulated videolaryngoscopy

Abstract

Videolaryngoscopy has largely solved the problem of seeing the larynx—but not necessarily the problem of intubating the trachea. Airway management has undergone a substantial transformation over the past decade, driven by the widespread adoption of videolaryngoscopy (VL) and a growing understanding of the role of human factors in airway-related morbidity and mortality. International guidelines and consensus statements increasingly support VL as a first-line technique for tracheal intubation in both routine and difficult airways (1-6), citing improved glottic visualization, higher first-attempt success rates, and a reduction in airway-related complications (1,7). However, improved visualization does not automatically translate into successful tube delivery, particularly when hyperangulated blades are used, where airway geometry and tube-glottis alignment remain critical challenges (8-10).