LAUSR

DOI:10.1097/ACO.0000000000000799 New technological developments as well as scientific evidence regarding anaesthesia can result in increased patient safety and can move established boundaries. Some examples of these exciting and inspiring developments are reviewed in this edition of the Technology, Education and Safety section of Current Opinion in Anesthesiology. For several years, flexible fiberoptic bronchoscopy has been the gold standard in the management of a difficult airway in awake patients. However, with recent developments of new-generation videolaryngoscopes, the question arises whether these scopes also have a place in the difficult airway algorithms. Moore and Schricker reviewed the randomized controlled trials that compared videolaryngoscopy and fiberoptic bronchoscopy during awake endotracheal intubation and suggested that videolaryngoscopy-assisted endotracheal intubation is indeed a valid first-line strategy for anticipated difficult airways [1]. They reported similar success rates and faster intubation times with videolaryngoscopy compared to flexible bronchoscopy. Will this be the end of flexible bronchoscopy in the management of difficult airways in awake patients? No, it is unlikely that video-laryngoscopy will replace flexible bronchoscopy. There will always remain specific indications for awake flexible bronchoscopy, but video-laryngoscopy will also be considered within the difficult airway algorithms. The teaching programs on anaesthesiology should take into account these new developments. Another field where the boundaries are moving is procedural sedation outside the operating room. Anaesthesiologists have to get habituated with spontaneously breathing patients with an unsecured airway, while they are sedated sufficiently deep to tolerate complicated and occasionally long-lasting procedures. The indications for sedation are increasing in patients with increasing age and comorbidities. Often, procedural sedation is regarded less invasive when compared to general anaesthesia, but is this really always the case? Procedural sedation has its own risks and complications. It requires adequate preassessment, especially of the airway, cardiovascular and respiratory monitoring during the procedure, and postprocedural care after the patient is discharged from the hospital.