Videolaryngoscopy: the more I practise, the luckier I get

<span class="paragraphSection">Editor—We would like to comment on two recent manuscripts that compared the performance of videolaryngoscopes in manikins and simulated difficult laryngoscopy in patients.<a href="#aex019-B1" class="reflinks">¹</a><a href="#aex019-B2" class="reflinks">²</a> Both manuscripts provided useful steps in our understanding of the variability of intubation performance using videolaryngoscopes. Ultimately, they suggested that differences in performance between devices relate to their design, the nature of the airway difficulty, or indeed, the type of user. Anaesthetists quite rightly consider themselves expert in all matters airway. However, as a result we believe there is an unsupported assumption that somehow expertise in Macintosh laryngoscopy equates to similar levels of performance with novel laryngoscopes. Indeed, Kleine-Brueggeney and colleagues<a href="#aex019-B1" class="reflinks">¹</a> allowed their group of airway experts to self-assess their competence with videolaryngoscopes before study commencement. However, it is known that self-assessment of performance is subject to many confounders and is unreliable.<a href="#aex019-B3" class="reflinks">³</a> Therefore, we believe that a major consideration in device performance is the current expertise of the user and the efficacy of any teaching intervention on skill acquisition. If we consider the two studies in question, the recruits had little opportunity to learn and practise with videolaryngoscopes, which they had seldom if ever used, thus maintaining an expertise gap. It is unsurprising then, that airway experts performed best with non-channelled, Macintosh-like videolaryngoscopes.<a href="#aex019-B1" class="reflinks">¹</a></span>

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