British Journal of Anaesthesia, 2003, Vol. 90, No. 5 705-706
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Correspondence |
Tracheal intubation using a Macintosh laryngoscope or a GlideScope® in 15 patients with cervical spine immobilization
Rome, Itlay
Editor—The use of rigid fibrescopes that incorporate tracheal tubes does not allow for independent movement of the fibrescope to allow visualization of the glottis while inserting the tube.1–3 This produces particular problems in patients with cervical rigidity.4 In addition, these devices all suffer from fogging and obstruction of the lens.5
The GlideScope® (Saturn Biomedical Systems Inc, Burnaby, British Columbia, Canada; retail price US$6500–7000 including monitor) is a new video laryngoscope that may be a useful alternative in difficult airway management. The GlideScope® incorporates a high resolution digital camera located in the middle of the blade tip. The glottis is visualized through a video cable, using a high resolution LCD monitor. The blade design of the GlideScope® has several advantages; an embedded anti-fogging mechanism, a reduced overall thickness of 18 mm, and a 60° curvature to match the anatomical alignment (Fig. 1).
|
The object of the study was to compare the Cormack grade6 obtained initially with a Macintosh laryngoscope and then with the GlideScope®, in 15 patients presenting for general anaesthesia who were wearing cervical collars. Informed written consent was required for inclusion in the study.
The camera portion of the GlideScope® is inserted along the middle of the tongue and the tip is positioned in the vallecula. The epiglottis is elevated by lifting the blade into the vallecula. A view of the epiglottis and glottis is available on the monitor as soon as the camera section of the GlideScope® enters the mouth. The tube stylet is an important part of intubation with the GlideScope®. It is curved to follow the 60° angulation of the GlideScope® blade. The Cormack grade (I–IV) and ease of tracheal insertion were evaluated in each patient.
The Cormack grading in 14 of the 15 patients (93%) was reduced by one when using the GlideScope®. One Grade IV patient and eight out of nine Grade III patients on direct laryngoscopy became Grades III and II respectively on using the GlideScope®. One patient classified as Grade III using direct laryngoscopy remained a Grade III with the GlideScope®. This patient was intubated using a gum elastic bougie under continuous vision provided by the GlideScope®. In addition, five Grade II patients became Grade I using the GlideScope®. The average time of intubation with the GlideScope® was 38 s. No complications, including no trauma to the teeth, were observed. In order to carry out tracheal intubation using the GlideScope®, the stylet inside the tracheal tube and the GlideScope® were withdrawn approx 4 cm and 1 cm, respectively.
These results demonstrate that the GlideScope® provides adequate vision of the glottis even when the oral, pharyngeal and laryngeal axes are not aligned.
F. Agrò
G. Barzoi
F. Montecchia
Rome, Itlay
References
1 Smith CE, Sidhu TS, Lever J, Pinchak AB. The complexity of tracheal intubation using rigid fiberoptic laryngoscopy (WuScope). Anesth Analg 1999; 89: 236–9
2 Smith CE, Boyer D. Cricoid pressure decreases ease of tracheal intubation using fibreoptic laryngoscopy (WuScope System). Can J Anaesth 2002; 49: 614–19
3 Levitan RM, Kush S, Hollander JE. Devices for difficult airway management in academic emergency departments: results of a national survey. Ann Emerg Med 1999; 33: 694–8[Medline]
4 Hastings RH, Vigil AC, Hanna R, Yang BY, Sartoris DJ. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology 1995; 82: 859–69[ISI][Medline]
5 Foley LJ, Ochroch EA. Bridges to establish an emergency airway and alternate intubating techniques. Crit Care Clin 2000; 16: 429–44[Medline]
6 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11[ISI][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Byhahn, S. Nemetz, R. Breitkreutz, B. Zwissler, M. Kaufmann, and D. Meininger Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway: [Compte-rendu court : L'intubation tracheale a l'aide du fibroscope d'intubation Bonfils ou la laryngoscopie directe pour le traitement de patients presentant des voies aeriennes difficiles simulees] Can J Anesth, April 1, 2008; 55(4): 232 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Robitaille, S. R. Williams, M.-H. Tremblay, F. Guilbert, M. Theriault, and P. Drolet Cervical Spine Motion During Tracheal Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus GlideScope(R) Videolaryngoscopy Anesth. Analg., March 1, 2008; 106(3): 935 - 941. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Shippey, D. Ray, and D. McKeown Case series: The McGrath(R) videolaryngoscope - an initial clinical evaluation: [Serie de cas : Le videolaryngoscope McGrath(R) - une premiere evaluation clinique] Can J Anesth, April 1, 2007; 54(4): 307 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Cooper Complications associated with the use of the GlideScope(R) videolaryngoscope: [Complications suite a l'utilisation du videolaryngoscope GlideScope(R)] Can J Anesth, January 1, 2007; 54(1): 54 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Falco-Molmeneu, F. Ramirez-Montero, R. Carregui-Tuson, N. Santamaria-Arribas, T. Gallen-Jaime, and M. Vila-Sanchez The modified Eschmann guide to facilitate tracheal intubation using the GlideScope(R). Can J Anesth, June 1, 2006; 53(6): 633 - 634. [Full Text] [PDF]
|
|
|
|
|
|
T. P. Turkstra, R. A. Craen, D. M. Pelz, and A. W. Gelb Cervical Spine Motion: A Fluoroscopic Comparison During Intubation with Lighted Stylet, GlideScope, and Macintosh Laryngoscope Anesth. Analg., September 1, 2005; 101(3): 910 - 915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Zura, D. J. Doyle, and M. Orlandi Use of the Aintree intubation catheter(R) in a patient with an unexpected difficult airway: [L'usage d'un Aintree intubation catheter(R) dans un cas d'intubation difficile imprevue] Can J Anesth, June 1, 2005; 52(6): 646 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Cooper, J. A. Pacey, M. J. Bishop, and S. A. McCluskey Early clinical experience with a new videolaryngoscope (GlideScope(R)) in 728 patients: [Experience clinique preliminaire avec un nouveau videolaryngoscope (GlideScope(R)) chez 728 patients] Can J Anesth, February 1, 2005; 52(2): 191 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Hung and M. Murphy Changing practice in airway management: are we there yet?/Evolution dans le controle des voies aeriennes : y sommes-nous deja ? Can J Anesth, December 1, 2004; 51(10): 963 - 968. [Full Text] [PDF]
|
|
|
|
|
|
K. Supbornsug and I. P. Osborn Topicalization of the Airway Using the GlideScope Anesth. Analg., October 1, 2004; 99(4): 1263 - 1264. [Full Text] [PDF]
|
|
|
|
|
|
Y. Lim, T.-J. Lim, and E. H.C. Liu Ease of intubation with the GlideScope or Macintosh laryngoscope by inexperienced operators in simulated difficult airways Can J Anesth, June 1, 2004; 51(6): 641 - 642. [Full Text]
|
|
|
|
|
|
D. J. Doyle Miniaturizing the GlideScope(R) video laryngoscope system: a new design for enhanced portability Can J Anesth, June 1, 2004; 51(6): 642 - 643. [Full Text]
|
|
|
|
|
|
R. M. Cooper Laryngoscopy -- its past and future Can J Anesth, June 1, 2004; 51(suppl_1): R6 - R6. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Doyle Awake intubation using the GlideScope(R) video laryngoscope: initial experience in four cases Can J Anesth, May 1, 2004; 51(5): 520 - 521. [Full Text]
|
|
|
|
|
|
D. J. Doyle, A. Zura, and M. Ramachandran Videolaryngoscopy in the management of the difficult airway Can J Anesth, January 1, 2004; 51(1): 95 - 95. [Full Text]
|
|
|
|
|
|
R. M. Cooper REPLY Can J Anesth, January 1, 2004; 51(1): 95 - 96. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||