First-Line Videolaryngoscopy: Commentary on the 2025 DAS Guidelines
Benjamin T. Fedeles, M.D.
Major, USAF Medical Corps & Clinical Advisor
“...emphasize the importance of maximizing the chances of success, rather than the avoidance and management of failure, to improve outcomes for patients undergoing airway management.”
, 2025 DAS Guidelines Core Philosophy
In November 2025, the British Journal of Anesthesiology published new updated Difficult Airway Society (DAS) guidelines for the Management of unanticipated difficult tracheal intubation in adults. This update reflects advances in airway management technology along with newer mental models and approaches developed over the past decade.
A three-round Delphi approach reviewed 1,241 papers over the course of three years, providing 65 key recommendations across critical clinical domains.
The DAS Algorithm
Plan A
Tracheal Intubation
Plan B
Supraglottic Airway
Plan C
Facemask Ventilation
Plan D
Front-of-Neck Airway
The linear approach to airway management: from tracheal intubation to emergency front-of-neck airway
Major Domains with Recommendations
The Case for First-Line Videolaryngoscopy
One of the most critical recommendations comes from the Plan A: Tracheal Intubation section. Evidence suggests videolaryngoscopes are effective at:
- •Increasing first-attempt success rates
- •Reducing hypoxaemia during intubation
- •Reducing the risk of oesophageal intubation compared with direct laryngoscopes
“Videolaryngoscopy improves the safety and efficacy of tracheal intubation compared with direct laryngoscopy across a range of patients, settings, and operators.”
, 2025 DAS Guidelines, Plan A
Enhanced Situational Awareness
Videolaryngoscopes also provide greater situational awareness to the team, allowing for:
- •Optimization of patient anatomy or position
- •Alternative approaches when needed
- •A more accurate perception of the intubation attempt
- •Greater speed moving down the DAS algorithm if required
Key Conclusion
Videolaryngoscopy has emerged as the first-line approach to difficult airway management. A videolaryngoscope should be used first line to facilitate tracheal intubation whenever possible.
Coming Soon
Additional parts to this series will focus on key takeaways regarding airway assessment, physiologically difficult airway, and human factors/education/training.
About the Author
Benjamin T. Fedeles, M.D.
Major, USAF Medical Corps & Clinical Advisor
Anesthesiology and Critical Care Medicine specialist serving as a Trauma and Airway Expert/Clinical Advisor for IntuBlade.
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