# Video-Assisted Endotracheal Intubation in Veterinary Patients


## Key Takeaways

- Video-assisted endotracheal intubation utilizes a camera on a laryngoscope or stylet to provide a screen-based visualization of the airway, decoupling the operator's eye from the direct line of sight required for traditional laryngoscopy. This technique is particularly advantageous in patients with difficult airways, such as brachycephalic breeds, cats with small oral openings, or those with cervical masses, by offering a wider field of view and improved visualization of the laryngeal structures.
- Equipment selection is critical and should be tailored to patient size and anatomy, with rigid Macintosh-style blades suitable for most dogs and Miller-style blades or camera stylets often preferred for cats and smaller patients. The camera stylet approach, where the tube is threaded over the stylet, can be beneficial for navigating challenging airway angles or managing large tongues.
- Proper patient positioning, including head and neck extension to align oral, pharyngeal, and tracheal axes, is paramount, with adjustments for brachycephalic breeds (e.g., head elevation) and cats (e.g., neutral positioning). Preoxygenation, oropharyngeal suctioning, and lens preparation (antifogging, warming) are essential pre-intubation steps to optimize visualization and minimize fogging or debris obstruction.
- Confirmation of endotracheal tube placement relies on direct visualization of the tube passing through the rima glottidis, supplemented by capnography as the gold standard for verifying tracheal placement. Auscultation of bilateral lung sounds and absence of gastric sounds serve as secondary confirmations, reducing the risk of unrecognized esophageal intubation.
- Troubleshooting common failures such as lens fogging, saliva, or blood requires immediate intervention through lens cleaning, suctioning, and reapplication of antifog solutions. If the video view is lost or ineffective, operators must be prepared to revert to direct laryngoscopy or utilize adjuncts like a bougie for successful intubation.
- Potential complications include esophageal intubation (especially in brachycephalic breeds), laryngeal or tracheal trauma from forceful advancement, vagal stimulation leading to bradycardia, laryngospasm (particularly in cats), and cuff-related tracheal injury from overinflation. Continuous monitoring of heart rate, oxygen saturation, and mucous membrane color is crucial during and after the procedure.

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Video-assisted endotracheal intubation uses a camera-equipped laryngoscope or stylet to visualize the airway on a screen instead of through direct line of sight. This article provides a step-by-step guide to the technique in dogs and cats, with emphasis on equipment selection, patient positioning, and troubleshooting common failures. It is written for veterinary students and practitioners who already understand direct laryngoscopy and need a framework for transitioning to video guidance. Anesthetic drug protocols are outside the scope of this article.

The central clinical question is straightforward: when does video assistance improve your view of the larynx, and what do you do when the image does not match your expectations? The answer depends on understanding how the camera changes your spatial relationship to the airway. In direct laryngoscopy, your eye, the blade tip, and the larynx must align. Video laryngoscopy decouples that alignment. You can place the blade tip in the vallecula or over the epiglottis, then look at the screen while the camera looks where your eye cannot. This is particularly valuable in brachycephalic dogs, cats with small oral openings, and patients with cervical masses that restrict mouth opening.

## At a Glance

| Parameter | Decision or Fact |
|---|---|
| Primary indication | Difficult airway, brachycephalic conformation, limited mouth opening, teaching settings |
| Equipment types | Rigid video laryngoscope, camera stylet, fiberoptic bronchoscope with video adapter |
| Screen position | Place screen at eye level, within 30 to 60 cm of the operator's dominant eye |
| Blade selection | Match blade length to patient size, Macintosh-style blades for vallecula placement, Miller-style for epiglottic elevation |
| Tube guidance | Preload the endotracheal tube onto a stylet or camera stylet before entering the mouth |
| Confirmation | Visual passage through the rima glottidis plus capnography, do not rely on the image alone |
| Common failure | Fogging, saliva, or blood on the lens, correct with antifog solution and suction before insertion |
| Rescue technique | Fall back to direct laryngoscopy or bougie-assisted intubation if the video view is lost |

## Principles of Video Laryngoscopy

Video laryngoscopy changes the mechanics of airway visualization. The camera sits near the blade tip and transmits a wide-angle image to a screen. This creates a view that is wider than the direct line of sight but also distorted. Structures appear larger and closer than they are, and the angle of the larynx relative to the blade may look different on screen than it does in your visual memory of the same patient. You must learn to trust the screen while maintaining an awareness of where the blade tip actually sits in the airway.

The Göttingen minipig literature demonstrates the value of video-assisted intubation for teaching and for procedures where direct visualization is difficult. In that model, endotracheal intubation is performed whenever general anesthesia is induced, because it maintains a patent airway, permits assisted ventilation, and protects the airway from aspirates [Basic surgical techniques in the Göttingen minipig: intubation, bladder](https://pubmed.ncbi.nlm.nih.gov/21730947/). The same rationale applies to dogs and cats. The video approach does not change the indication for intubation, it changes the reliability of your view.

### Optical Principles

The camera lens sits at the distal tip of the blade or stylet. The image is transmitted either through a fiberoptic bundle or a digital sensor at the tip. Fiberoptic systems require careful handling because the bundles can break if the device is bent sharply. Digital systems are more robust but may have a slight image lag. Neither system performs well with fog or debris on the lens, so preparation matters more than with direct laryngoscopy.

The wide-angle lens creates a field of view of roughly 60 to 80 degrees. This is wider than the human visual field during direct laryngoscopy, which is why you can see the larynx even when the oral axis is not aligned with the pharyngeal axis. The trade-off is that depth perception is reduced. You cannot judge distance from the screen alone. You must use tactile feedback from the blade or stylet to know when the tip is at the laryngeal opening.

## Equipment Selection

Choose equipment based on patient size and the clinical scenario. A rigid video laryngoscope with a Macintosh-style blade works well for most dogs. The blade is placed in the vallecula, and the epiglottis is lifted indirectly. For cats and small dogs, a Miller-style blade is often better because it is straight and can lift the epiglottis directly. Some video laryngoscopes accept multiple blade sizes on the same handle, which is useful in a mixed practice.

Camera stylets are flexible rods with a camera at the tip. They are threaded through the endotracheal tube so that the tube follows the stylet into the trachea. The stylet is then withdrawn, leaving the tube in place. This approach is useful when the larynx is positioned cranially or when the patient has a large tongue that obscures the blade view. The stylet can be shaped with a gentle curve to match the patient's airway angle.

### Screen and Light Source

The screen should be bright enough to see in ambient operating room light. Most modern units have built-in LED illumination at the tip. Check the battery level before induction. A dead battery mid-intubation is a failure mode that is entirely preventable. Position the screen at eye level and within comfortable viewing distance. If you must turn your head or lean over the patient to see the screen, your hand position on the blade will drift.

## Patient Positioning and Preparation

Position the patient in sternal recumbency with the head and neck extended along a straight axis. This aligns the oral, pharyngeal, and tracheal axes as much as the patient's conformation allows. In brachycephalic dogs, the head may need to be elevated on a towel roll to achieve the same alignment. Cats often tolerate dorsal recumbency with the head extended, which some operators find easier for video laryngoscopy because the larynx sits more directly in line with the camera.

Preoxygenate for three to five minutes before induction. Have suction ready and clear the oropharynx of saliva or debris before inserting the blade. Apply antifog solution to the lens and warm the tip in sterile saline if the device allows it. Cold lenses fog rapidly in a warm, humid airway.

## Technique for Dogs

Insert the blade at the corner of the mouth and advance it along the tongue toward the epiglottis. Watch the screen as you advance. The tongue will appear as a large pink mass that fills the lower half of the image. Advance until the epiglottis comes into view. For a Macintosh blade, place the tip in the vallecula and lift along the axis of the handle. For a Miller blade, place the tip over the epiglottis and lift it directly.

Once the rima glottidis is visible, pass the endotracheal tube through the vocal folds. If you are using a stylet, the tube should be preloaded with the stylet tip just inside the tube's distal opening. Advance the tube until the cuff is past the vocal folds, then withdraw the stylet. Confirm placement by watching the tube pass between the vocal folds on the screen, then attach the anesthetic circuit and confirm with capnography.

## Technique for Cats

Cats present a narrower airway and a more reactive larynx. Use the smallest appropriate blade and tube. The arytenoid cartilages are easily traumatised, so avoid advancing the tube against resistance. If the larynx is not visible within 30 seconds of blade insertion, stop and reassess. Reposition the head, suction the pharynx, or switch to a camera stylet.

Lidocaine applied topically to the larynx before intubation reduces laryngospasm, but the dose must be calculated carefully for feline patients. Consult a current formulary for species-specific dosing. The video view does not protect the larynx from trauma, it only improves your ability to see it.

## Troubleshooting

Fogging is the most common problem. Remove the device, wipe the lens, reapply antifog, and reinsert. Saliva and blood behave the same way. Suction the pharynx before inserting the device and again if the view degrades.

A red or dark image usually means the tip is against mucosa. Withdraw slightly until the image clears. A white image means the tip is against the epiglottis or pharyngeal wall. Rotate the blade slightly to find the airway.

If the larynx is visible but the tube will not pass, the tube may be catching on the arytenoid cartilage or the cuff may be partially inflated. Deflate the cuff completely and rotate the tube 90 degrees. If the tube still will not pass, consider a smaller tube or a bougie. Bougie-assisted techniques have been shown to be faster and easier than standard approaches in emergency airway training models [Cricothyrotomy technique using gum elastic bougie is faster than](https://pubmed.ncbi.nlm.nih.gov/20491685/). The same principle applies in veterinary patients when the laryngeal opening is small or the view is partial.

If the video system fails entirely, do not persist. Remove the device and perform direct laryngoscopy. The patient's airway is the priority, not the equipment. Practice the technique on routine intubations before relying on it for difficult airways.

## Confirmation of Tube Placement

The video laryngoscope provides a distinct advantage during confirmation of endotracheal tube placement because the operator can observe the tube passing between the vocal folds in real time. This visual confirmation is the primary method when using video laryngoscopy, and it should be supplemented with the same secondary checks used in conventional intubation.

Capnography remains the gold standard for confirming tracheal placement once the patient is connected to the breathing circuit. A waveform that shows consistent carbon dioxide production over several breaths confirms tracheal intubation. The absence of a capnographic waveform after six ventilations should prompt immediate reassessment, as esophageal intubation produces no carbon dioxide and gastric insufflation may produce a small, rapidly declining trace.

Auscultation of the thorax and over the cervical trachea provides additional information. Bilateral lung sounds with absent sounds over the epigastrium support tracheal placement, but auscultation alone is unreliable in small patients and in those with obesity or pleural disease. The combination of direct visualization, capnography, and auscultation reduces the risk of unrecognised esophageal intubation to a minimum.

The video image should be retained until the tube is secured. Once the tube is tied or taped in place, the laryngoscope blade is withdrawn while the tube is held firmly at the lips. The operator should confirm that the depth mark at the lips has not changed after withdrawal of the blade, as the blade can displace the tube during removal.

## Monitoring During and After Intubation

The patient's physiological response to intubation provides immediate feedback on technique quality. Heart rate and rhythm should be observed continuously during laryngoscopy. A vagal response to laryngoscope blade pressure or to tracheal stimulation can produce bradycardia, particularly in cats and in brachycephalic dogs. The operator should pause, withdraw the blade slightly, and allow the heart rate to recover before attempting further advancement.

Oxygen saturation measured by pulse oximetry detects desaturation during prolonged attempts. A fall below 94 percent in a patient breathing oxygen indicates that the attempt should be abandoned temporarily, the patient should be reoxygenated by mask or by manual ventilation, and the approach should be reconsidered. The duration of each attempt should be limited to 30 to 45 seconds in most patients, with shorter limits in compromised individuals.

Mucous membrane color and capillary refill time are simple indicators of perfusion and oxygenation during the procedure. These parameters are less sensitive than pulse oximetry but remain useful when a pulse oximeter is unavailable or when the probe site is poorly perfused.

After the tube is secured, the cuff should be inflated to the minimal pressure that prevents an audible air leak at the peak inspiratory pressure used for the patient. Cuff pressure should be measured with a manometer when available. Excessive cuff pressure can cause tracheal mucosal ischemia, and the risk is highest in cats and small dogs with narrow tracheas. The anesthetist should recheck cuff pressure periodically during prolonged procedures.

The video laryngoscope screen should be cleaned and disinfected after each use according to the manufacturer's instructions. The blade should be inspected for damage, particularly at the distal tip and around the camera lens, before it is returned to storage.

## Documentation

The medical record should include the method of intubation, the size and type of endotracheal tube used, the depth of the tube at the lips, the cuff inflation volume or pressure, and the number of attempts required. Any difficulty encountered during intubation should be described specifically, including the reason for difficulty and the corrective action taken.

The confirmation methods used should be recorded, including direct visualization, capnography, and auscultation. The patient's physiological parameters during the procedure, including heart rate, rhythm, and oxygen saturation, should be noted. Any complications, such as trauma to the oral cavity, larynx, or trachea, should be documented with a description of the injury and the follow-up plan.

Photographic or video capture from the laryngoscope screen can be stored in the patient record when the equipment supports this function. These images provide objective documentation of laryngeal appearance and tube position and can be useful for teaching and for comparison in patients requiring repeated intubations.

## Comparison of Video Laryngoscope Types

The choice of video laryngoscope depends on the patient population, the clinical setting, and the operator's experience. The table below compares the main categories of devices available for veterinary use.

| Device Type | Design | Advantages | Limitations | Best Use |
|---|---|---|---|---|
| Rigid video laryngoscope with Macintosh-style blade | Blade with camera and light source at the distal third | Familiar blade shape, allows direct and indirect visualization, robust construction | Blade size limited by patient size, cost of purchase and repair | Dogs over 5 kg, routine intubations in practice |
| Rigid video laryngoscope with hyperangulated blade | Blade with pronounced curvature, camera at the tip | Improved visualization of the laryngeal inlet in difficult airways, less need to align oral, pharyngeal, and tracheal axes | Requires styletted tube, unfamiliar technique, limited space for tube passage alongside the blade | Brachycephalic dogs, patients with limited mouth opening, rescue intubation |
| Flexible video endoscope | Long, flexible insertion tube with steerable tip | Can be used for nasal intubation, can navigate tortuous airways, useful for bronchoscopy | Expensive, fragile, requires cleaning and disinfection, more skill to operate | Cats, small dogs, nasal intubation, patients with laryngeal masses |
| Smartphone-mounted video laryngoscope | Rigid blade with camera that attaches to a smartphone | Low cost, portable, uses existing technology, image can be recorded | Image quality varies, smartphone battery dependence, less robust in high-use settings | Teaching settings, low-resource practices, occasional use |

The rigid Macintosh-style device is the most versatile choice for a general small animal practice. The hyperangulated blade is reserved for patients with known or anticipated difficult airways. The flexible endoscope is the preferred option for cats and for patients requiring nasal intubation, as the rigid blades designed for dogs are often too large for feline patients. The smartphone-mounted device is a reasonable entry point for practices adopting video laryngoscopy for the first time, but it should not be relied upon as the sole device in a busy hospital.

## Troubleshooting Sequence for Common Challenges

When the laryngeal inlet cannot be visualized, the operator should work through a systematic sequence of corrective actions instead of repeating the same attempt.

First, reassess the patient's head position. The head should be extended at the atlanto-occipital joint with the neck in a neutral to slightly extended position. A rolled towel under the neck can improve alignment in dogs with thick necks. In cats, excessive extension can actually worsen visualization, so the head should be positioned more neutrally.

Second, check the depth of anesthesia. Jaw tone, palpebral reflexes, and the presence of swallowing movements indicate that the patient is too light. The anesthetic plane should be deepened before further attempts. A patient that is too light will also have active laryngeal reflexes that cause the vocal folds to adduct during the procedure.

Third, evaluate the amount of foam or saliva in the oropharynx. The suction tip should be passed alongside the blade, not through the working channel, in most rigid video laryngoscopes. The laryngeal inlet should be cleared of fluid before attempting tube passage.

Fourth, consider the effect of the blade position on the soft palate. In brachycephalic dogs, the elongated soft palate can obscure the laryngeal inlet. The blade tip should be used to elevate the soft palate dorsally, which often reveals the arytenoid cartilages and the vocal folds.

Fifth, if the laryngeal inlet is visible but the tube will not pass, the tube may be catching on the arytenoid cartilages or the corniculate processes. Rotating the tube 90 degrees so that the bevel faces laterally can help the tip pass between the vocal folds. A stylet that is shaped to follow the curvature of the blade can also facilitate passage.

Sixth, if the tube passes but the patient desaturates or the capnograph shows no carbon dioxide, the tube should be withdrawn and the patient reoxygenated before a further attempt. Repeated blind passage of the tube increases the risk of trauma to the larynx and trachea.

Finally, if all attempts fail and the patient cannot be ventilated by mask, the operator should consider an alternative airway approach. The gum elastic bougie can be used to guide tube placement when the laryngeal inlet is partially visible, and this technique has been shown to be faster and easier to perform than standard cricothyrotomy in inexperienced operators working in an animal laboratory setting [Hill et al., cricothyrotomy technique using gum elastic bougie](https://pubmed.ncbi.nlm.nih.gov/20491685/). Surgical airway access is a rescue technique that should be considered before the patient becomes hypoxic.

The video laryngoscope image should be reviewed after each attempt to identify the specific reason for failure. This feedback loop allows the operator to correct the underlying problem instead of repeating the same unsuccessful approach.

## Recognized Complications and Early Detection

Video laryngoscopy reduces, but does not eliminate, the classic complications of endotracheal intubation. Esophageal intubation remains the most consequential failure mode. The video image can mislead when the laryngeal opening is not fully visualized, particularly in brachycephalic dogs where redundant soft tissue obscures the glottis. Detect esophageal placement by observing the tube tip pass beyond the laryngeal aditus on screen, then confirm with capnography. A sustained absent waveform after six ventilations warrants immediate extubation and reattempt.

Trauma to the larynx or trachea occurs when the stylet protrudes beyond the tube tip or when the tube is advanced with excessive force. The video image shows the arytenoid cartilages indenting before the tube passes. Stop and rotate the tube if resistance is felt. Minor mucosal abrasion may produce blood on the tube tip, visible on the screen after withdrawal. Significant hemorrhage, progressive swelling, or dyspnoea after extubation requires airway assessment and possible reintubation.

Vagal stimulation from laryngeal manipulation can cause bradycardia or transient hypotension. The clinician should watch the patient, also the screen. If heart rate drops, pause manipulation and allow the patient to stabilize before continuing. In cats, laryngospasm is a recognized risk, especially with light anesthetic planes. The video image shows adducted arytenoids and a narrowed glottic opening. Stop advancing, deepen the plane, and apply topical lidocaine before reattempting.

Cuff-related injury, including tracheal mucosal ischemia or rupture, follows overinflation. Use a cuff pressure manometer where available. The video image does not show cuff pressure, so the operator must track inflation volume and resistance. In small cats, even modest overinflation can compromise tracheal blood flow.

## Common Errors and Corrective Action

Less experienced operators frequently advance the tube when the laryngeal view is incomplete. The video screen creates a false sense of certainty. The corrective habit is to require a clear view of both arytenoid cartilages and the glottic opening before advancing the tube. If the view is partial, stop and reposition.

Failure to maintain the tube tip in the center of the screen during advancement is another common error. The tip drifts dorsally into the esophagus or ventrally into the ventral laryngeal recess. Watch the tip continuously, not the glottis, during the final 2 cm of advancement.

Overshooting the tracheal mid-cervical region occurs when the tube is advanced too far, particularly in cats. The tube tip may enter a mainstem bronchus. The video image cannot confirm distal position. Use the depth mark on the tube at the incisors or nares, then confirm with auscultation and capnography.

Inadequate lubrication or an inappropriately sized tube causes avoidable resistance. The operator should select the tube based on body weight and breed, then verify that it passes through the glottis with minimal force. If resistance is felt, withdraw and reassess instead of forcing.

## Limitations of Current Evidence

The evidence base for video laryngoscopy in veterinary patients is limited. Most published work on video-assisted intubation techniques comes from human medicine or from animal models used for human surgical training, such as the Göttingen minipig instructional material and the sheep model for cricothyrotomy training. These sources demonstrate procedural feasibility and teaching utility, but they do not establish comparative efficacy in dogs and cats.

Expert opinion still differs on several points. Some clinicians advocate routine video laryngoscopy for all feline intubations, while others reserve it for difficult airways. There is no published consensus on whether video guidance reduces complication rates in general veterinary practice. The RCVS Day One Competences require graduates to perform endotracheal intubation safely, but they do not specify a preferred technique. The MSD Veterinary Manual describes standard intubation technique and its complications, but video laryngoscopy is not yet covered as a distinct method in all editions.

Equipment cost and cleaning requirements remain practical barriers. Single-use blades reduce cross-contamination risk but increase per-procedure cost. Reusable blades require careful cleaning between patients, and the optical components are fragile.

## Escalation and Referral

Most intubation difficulties are managed within the practice. Referral or specialist consultation is warranted when the airway cannot be secured despite multiple attempts, when laryngeal trauma is suspected, or when the patient develops progressive respiratory distress after extubation. A veterinary emergency and critical care specialist should be contacted early in these situations, not after the patient deteriorates.

Laboratory involvement is rarely needed for routine intubation. Blood gas analysis may be indicated when prolonged attempts have caused hypoxemia or hypercapnia. If the patient develops arrhythmias during intubation, an electrocardiogram and serum electrolyte measurement are appropriate.

Regulatory reporting is not typically required for intubation complications. However, if a device failure causes patient harm, the manufacturer should be notified. In some regions, adverse event reporting to a national veterinary pharmacovigilance or device surveillance program may be expected. The AVMA practice resources provide guidance on professional standards and liability considerations. International standards for veterinary practice and welfare, such as those published by WOAH, may apply in research or production animal settings.

| Observation | Likely Cause | Discriminating Check |
|---|---|---|
| Tube tip visible but no capnography waveform | Esophageal intubation | Withdraw tube to pharynx, reattempt with full glottic view |
| Arytenoids adduct as tube approaches | Laryngospasm or light plane | Deepen anesthesia, apply topical lidocaine, wait 30 seconds |
| Blood on tube tip after withdrawal | Mucosal abrasion | Assess larynx visually, monitor for swelling or dyspnoea |
| Tube advances easily but breath sounds absent on one side | Mainstem bronchus intubation | Auscultate both hemithoraces, withdraw tube 1 to 2 cm |
| Screen image clear but tube will not pass | Stylet protruding or tube too large | Check stylet position, verify tube size against body weight |
| Cuff inflates with very low volume | Cuff herniation or tube too small | Deflate, consider larger tube, verify seal with pilot balloon |

## Frequently Asked Questions

### How much does video laryngoscopy cost, and when is it worth the investment?

Video laryngoscope systems range from handheld single-use devices to reusable units with integrated screens. Reusable systems cost more upfront but reduce per-patient consumable expense. The investment is most justified in high-volume anesthesia practices, referral settings with brachycephalic or critical patients, and teaching hospitals where direct visualization of technique accelerates student learning. For low-volume general practice, a conventional laryngoscope with good technique remains adequate for most routine intubations. Consider rental or shared-equipment arrangements with nearby referral practices if caseload does not justify purchase. The [RCVS Day One Competences](https://www.rcvs.org.uk/setting-standards/undergraduate-education/) require graduates to perform intubation safely, and video systems can support that training without replacing fundamental manual skills.

### What should I do when a video laryngoscope is unavailable but intubation is difficult?

Return to fundamentals. Optimize positioning, ensure adequate anesthetic depth, and use a conventional laryngoscope with a curved blade for dogs or a straight blade for cats. Have a styletted tube preloaded and a bougie or catheter guide within reach. Apply gentle external laryngeal pressure to bring the glottis into view. If the glottis cannot be visualized, blind digital palpation in larger dogs or retrograde intubation through a percutaneous guidewire are salvage options. In cats, topical lidocaine applied to the laryngeal mucosa before attempts reduces laryngospasm. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) describes alternative airway access techniques including emergency tracheostomy when oral intubation fails repeatedly. Practice these fallback methods on cadavers or simulation models before you need them in a crisis.

### Does video laryngoscopy work for species other than dogs and cats?

Video laryngoscopy has been described in minipigs, where the technique follows the same principles as in companion animals and permits use of human-sized equipment [intubation technique in the Göttingen minipig](https://pubmed.ncbi.nlm.nih.gov/21730947/). In horses, video-assisted approaches have been used for instrumentation of the airway and gastrointestinal tract, though the long oral cavity and epiglottic entrapment risk require longer blades and different patient positioning [video-assisted instrumentation in horses](https://pubmed.ncbi.nlm.nih.gov/34856499/). Small ruminants and pigs have oropharyngeal anatomy that differs substantially from carnivores, so blade selection and tube curvature must be adjusted. The camera and screen components are species-agnostic, the limiting factors are blade length, curvature, and the availability of appropriately sized endotracheal tubes. Consult species-specific references before attempting video-guided intubation in non-traditional patients.

### What should I record in the anesthesia record regarding video laryngoscopy?

Record the device used, blade size, number of intubation attempts, and any difficulty encountered. Note the time from induction to confirmed tube placement, because prolonged attempts increase hypoxemia risk. Document the method of tube position confirmation, whether capnography, auscultation, or both. If the video system was used to visualize the glottis, record that the view was adequate or note the grade of laryngeal visualization. Any complications such as bleeding, laryngospasm, or esophageal intubation must be documented with the corrective action taken. The [AVMA practice resources](https://www.avma.org/resources-tools) emphasize that accurate medical records support continuity of care and medicolegal defense. This information also guides future intubation attempts in the same patient, particularly if anatomical challenges were identified.

### How do I explain the need for video laryngoscopy to a client?

Frame the conversation around safety and efficiency. Explain that visualizing the airway during tube placement reduces the risk of complications such as trauma to the larynx or accidental esophageal intubation. Avoid technical jargon. State that the video system is a tool that helps the veterinary team place the breathing tube accurately, especially in patients with challenging anatomy such as flat-faced breeds. If the practice charges a fee for advanced airway management, disclose this clearly during the consent process. The [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) emphasize that animal welfare includes minimizing distress during procedures, and a smooth intubation with fewer attempts serves that goal. Clients generally respond well when the explanation links the technology directly to reduced risk for their animal.

### When should I abandon video laryngoscopy and switch to another technique?

Abandon the video approach if the lens fogs repeatedly, the image remains obscured despite suction and antifogging measures, or the device fails electronically. Also switch if more than two attempts have failed, because repeated laryngoscopy causes airway edema and bleeding that worsen the view. Move to a conventional laryngoscope with a bougie, or proceed directly to surgical airway access if the patient is deteriorating. In sheep, a bougie-assisted cricothyrotomy technique was faster and easier for inexperienced operators than the standard approach, suggesting that having a defined rescue plan improves outcomes [bougie-assisted cricothyrotomy in an animal lab](https://pubmed.ncbi.nlm.nih.gov/20491685/). Time yourself mentally during attempts and set a personal threshold for escalating to a different method before hypoxia develops.

## Related Clinical & Scientific Guides

* [Veterinary Case Presentation: Structure and Delivery](/knowledge/veterinary-medicine/clinical-skills-training/veterinary-case-presentation-structure-delivery)
* [Veterinary Communication in the Workplace: Team Dynamics](/knowledge/veterinary-medicine/clinical-skills-training/veterinary-communication-workplace-team-dynamics)
* [Monitoring Plans for Hospitalized Veterinary Patients](/knowledge/veterinary-medicine/clinical-skills-training/monitoring-plans-hospitalized-veterinary-patients)


## References and Further Reading

- [Basic surgical techniques in the Göttingen minipig: intubation, bladder catheterization, femoral vessel catheterization, and transcardial perfusion.](https://pubmed.ncbi.nlm.nih.gov/21730947/). 2011.
- [Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab.](https://pubmed.ncbi.nlm.nih.gov/20491685/). 2010.
- [Simulated Zenker's endoscopic staple-assisted esophagodiverticulostomy (ESED) surgery.](https://pubmed.ncbi.nlm.nih.gov/12169904/). 2002.
- [Animal Model of Video-Assisted Cecum and Ileum Instrumentation for Equine Visceral Pain Study.](https://pubmed.ncbi.nlm.nih.gov/34856499/). 2022.
- [Animal Model of Video-Assisted Cecum and Ileum Instrumentation for Equine Visceral Pain Study](https://europepmc.org/article/AGR/IND607551140). 2022.
- [Video-assisted replacement or bypass grafting of the descending thoracic aorta with a new sutureless vascular prosthesis: an experimental study.](https://pubmed.ncbi.nlm.nih.gov/10436452/). 1999.
- [RCVS Day One Competences](https://www.rcvs.org.uk/setting-standards/undergraduate-education/). RCVS.
- [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual.
- [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association.

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- [Endotracheal Intubation in Veterinary Patients: Equipment and Technique](/knowledge/veterinary-medicine/clinical-skills-training/endotracheal-intubation-veterinary-patients-equipment-technique)
- [Endotracheal Intubation Procedure in Veterinary Emergencies](/knowledge/veterinary-medicine/clinical-skills-training/endotracheal-intubation-procedure-veterinary-emergencies)
- [Vet Wrap Bandage Techniques for Veterinary Patients](/knowledge/veterinary-medicine/clinical-skills-training/vet-wrap-bandage-techniques-veterinary-patients)
- [Monitoring Plans for Hospitalized Veterinary Patients](/knowledge/veterinary-medicine/clinical-skills-training/monitoring-plans-hospitalized-veterinary-patients)
- [Peripheral Venous Catheter Placement in Veterinary Patients](/knowledge/veterinary-medicine/clinical-skills-training/peripheral-venous-catheter-placement-veterinary)

> This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.