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BJA Advance Access published online on July 7, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael133
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted December 15, 2005

Clinical Investigation

The use of the GlideScope® for tracheal intubation in patients with ankylosing spondylitis

H. Y. Lai 1, I. H. Chen 2, A. Chen 1, F. Y. Hwang 3, and Y. Lee 1 *

1 Department of Anaesthesiology, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien 970, Taiwan
2 Department of Orthopaedics, Buddhist Tzu-Chi General Hospital, Tzu-Chi University, Hualien 970, Taiwan
3 Department of Anaesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan

* To whom correspondence should be addressed.
Y. Lee, E-mail: drleeyi2001{at}yahoo.com.tw


  Abstract

Background. The GlideScope® Video Laryngoscope is a new intubating device. The aim of the study was to investigate the use of the GlideScope® for tracheal intubation in patients with ankylosing spondylitis (AS) undergoing general anaesthesia.

Methods. Twenty AS patients were chosen to undergo tracheal intubation by the GlideScope®. Preoperative airway assessments were carried out to predict the difficulty of tracheal intubation. Before intubation all patients were given a modified Cormack and Lehane (MCLS) grade and percentage of glottic opening (POGO) score by a separate anaesthetist using a Macintosh size 3 blade. The patients were then intubated, using the GlideScope®, by a different anaesthetist during which the larynx was inspected and given another MCLS grade and POGO score.

Results. Twelve of the AS patients were judged to have had difficult intubation by preoperative airway assessment. Eleven of the twelve patients had MCLS grades III or IV by direct laryngoscopy and were considered to have had a difficult laryngoscopy. Naso-tracheal intubations by the GlideScope® were successful on 17/20 occasions, including 8 of the 11 difficult laryngoscopy. The GlideScope® improved the MCLS grade and POGO score in the majority of AS patients compared with direct laryngoscopy (P<0.01).

Conclusions. The GlideScope® provides a better laryngoscopic view than that of direct laryngoscopy. Most of the AS patients presenting with MCLS grade III or IV by direct laryngoscopy can be intubated successfully by the GlideScope®. In elective patients with AS, awake fibreoptic intubation offers a higher level of security because it can be applied while maintaining spontaneous breathing. The use of GlideScope® for tracheal intubation may be an alternative option in these patients who prefer their airway management under anaesthesia.

Keywords: anaesthetic techniques, laryngoscopy; disease, ankylosing spondylitis; equipment, GlideScope®; intubation, tracheal.
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