The Evolution of Laryngoscopy

The work of anesthesiologists–intensivists, critical care specialists, and medical emergency teams is multifaceted and complex, with airway management representing a cornerstone and a common denominator of many procedures and interventions. Tracheal intubation has represented, and still represents today, the gold standard for airway control. Laryngoscopy evolution has progressed in parallel with technological development and innovation, resulting in the evolution of new skills and in the expansion of possibilities and safety for patient care. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, with the consecration of the MacIntosh laryngoscope. Almost 50 years later, the world witnessed a pivotal turning point around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that have succeeded one another introduced new problems, driving the search for new solutions. At present day, tracheal intubation with videolaryngoscopy has achieved success and safety standards that are certainly superior, if not unimaginable, when compared with the early days of the technique. In this review we will retrace the historical aspects of the evolution of laryngoscopy, analyzing the problems that have emerged over time with the various devices and the solutions adopted. We will then examine the evolution of videolaryngoscopes, the impact of these devices on both technical skills and non-technical skills, as well as the debate surrounding their routine use (universal videolaryngoscopy) and the choice of the best adjuncts to optimize success during their use, including the application of assistive artificial intelligence to improve both success rates and the learning curve. This journey, after 150 years of evolution, has probably reached today the highest possible level of expression in terms of safety and efficacy.