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Seeing the cords
Teaching and learning the technique of endotracheal intubation is an enduring challenge for both the experienced intubator and the learner. Over the years, people have practised direct laryngoscopy and tracheal intubation on cadavers, cats and mannikins, or just ‘learned by doing’ on babies needing resuscitation after delivery. An alternative technique, indirect videolaryngoscopy, has been mainly used in restricted groups of patients with particular airway issues, mostly by anaesthetists. Its potential as a teaching device for neonatal intubation has recently been explored by O'Shea et al (Pediatrics 2015;136:912–9). In a trial with an innovative design, trainees used the videolaryngoscope as a direct device for intubation (ie, without the ‘video’), and the procedure was randomised to the trainer either seeing the screen, and using what was seen to give advice, or not seeing the screen and giving advice ‘blind’. The main outcome measure was the success rate, and this was found to be significantly better when the trainer could see the screen and advise accordingly. The authors point out that the apparatus for videolaryngoscopy does not lend itself to its routine use in neonatal intubation, for …