The Evolution of Laryngoscopy in Airway Management and Tracheal Intubation

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. This narrative review, conducted through a comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Library from database inception to December 2025 and supplemented by manual reference searches and retrieval of key historical sources, aims to trace the evolution of laryngoscopy for airway management and tracheal intubation—from its nineteenth-century origins to the current state of the art—while simultaneously addressing the clinical, educational, and safety implications of this evolution. Laryngoscopy evolution progressed in parallel with technological development and innovation, resulting in the expansion of clinical possibilities and in the improvement of patient safety. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, culminating in the widespread adoption of the Macintosh laryngoscope. Almost 50 years later, a pivotal turning point occurred around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that succeeded one another introduced new problems, driving the search for new solutions. At present, tracheal intubation with videolaryngoscopy has achieved success and safety standards substantially superior to those of the early days of the technique. In this review we retrace the historical milestones of laryngoscopy, analyze the problems that emerged over time with various devices and the solutions adopted, examine the evolution of videolaryngoscopes and the impact of these devices on both technical and non-technical skills, discuss the ongoing debate surrounding their routine use (universal videolaryngoscopy) and the selection of optimal adjunct devices, and outline the emerging role of artificial intelligence in improving success rates and facilitating the learning curve. This journey, after 150 years of evolution, has reached a high level of maturity in terms of safety and efficacy.