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Videolaryngoscopy in the management of the difficult airway

Cleveland, Ohio

To the Editor:

We read with interest Dr. Richard Cooper’s excellent recent report on using the GlideScope® in the management of a patient with a difficult airway.¹ In addition to Dr. Cooper’s series of 80 cases using the Glidescope®, we have used the Glidescope® in over 170 of our own cases in the five months we had the unit, including ten cases of awake intubation and several "airway rescues" where we were called in for assistance. One of the rescue cases was a failed direct laryngoscopy, failed fibreoptic intubation attempted following the induction of general anesthesia.

Referring to patients known to be difficult to intubate by conventional means, Dr. Cooper writes that use of the Glidescope® "challenges the prevailing wisdom that such patients must be managed by awake fibreoptic intubation". We wholeheartedly agree. Like Dr. Cooper, our experience with the unit has been highly favourable, and we fully expect that the Glidescope® will ultimately have a profound impact on clinical airway management.

One point that was not emphasized in Dr. Cooper’s report bears mentioning. We found that the principal limitation in using the Glidescope® was not in getting a good view of the glottis, but rather in manipulating the endotracheal tube (ETT) through the vocal cords. We also found that successful ETT placement was usually best achieved using a stylette formed in the shape of a "hockey stick" (with a 90° bend) to help ensure that the ETT could be directed sufficiently anteriorly to enter the glottis.

Finally, Dr Cooper writes "This case is the first publication describing the use of the GlideScope® videolaryngoscope". Unfortunately, while this was true at the time the article was in review, a prior report of 15 cases slipped into publication.²

References

1 Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.[Abstract/Free Full Text]

2 Agro F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization (Letter). Br J Anaesth 2003; 90: 705–6.[Free Full Text]

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