Cervical Injury after Videolaryngoscopy in Patient with Ankylosing Spondylitis: Comment

The recent article by Epaud et al.¹  reinforces the need for anesthesiologists to be comfortable with the flexible fiberoptic intubation technique. I read with great concern that a neurologic injury occurred because of the choice of videolaryngoscopy as the intubation approach because the operator was more familiar with that technique. Was the decision to use videolaryngoscopy a result of our anesthesiology training programs shifting the focus of difficult airway training to videolaryngoscopy because this technique is readily available and relatively easy to use compared to flexible fiberoptic intubation? It has been demonstrated that videolaryngoscopy does not significantly reduce cervical spine movement compared to direct laryngoscopy²  and, unfortunately, patient harm occurred in the authors’ case presentation.

The authors endorse that flexible fiberoptic intubation could have been used to avoid injury; the use of fiberoptic intubation mitigates cervical spine movement because it is flexible and can be manipulated in difficult anatomy presentations. A randomized clinical trial showed that there was no difference in intubation time and success rate³  between videolaryngoscopy and flexible fiberoptic intubation in experienced hands. That is the key: experience!

Anesthesiology residency programs should not compromise training in flexible fiberoptic intubation because of the relative ease of use and convenience of videolaryngoscopy, and American Board of Anesthesiology/Accreditation Council for Graduate Medical Education requirements should reflect this.

The author declares no competing interests.