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Correspondence |
Toronto, Ontario
I agree with Drs. Kaplan and Berci regarding the value of a video display while performing laryngoscopy. As they stated, this is particularly useful when teaching or supervising the procedure. I have also had the opportunity of using the Storz Video Macintosh Laryngoscope. With this device, the technique and laryngeal view are very similar to that seen by direct laryngoscopy, making it ideal for teaching purposes.
I am pleased that the experience of Dr. Doyle and colleagues has been similar to our own. The GlideScope® is proving effective in routine and difficult airways. At the time this intubation occurred (May 2002), my personal experience was limited to approximately 80 cases. We have now collected data on over 700 consecutive uses of this videolaryngoscope (manuscript in preparation) in a wide range of clinical settings. It is interesting to observe that many users have rapidly acquired the necessary confidence to choose this as a first-line management tool. Compared with conventional (i.e., direct) laryngoscopy, it appears that little force is required to obtain a good laryngeal view on the monitor. This may be less stimulating than direct laryngoscopy in the awake patient.
Dr. Doyle correctly points out that a good laryngeal view does not necessarily result in an easy, or indeed successful intubation. Several of the unsuccessful intubations in our series, occurred despite a Cormack-Lehane grade I or II view. Since this is not line-of-sight laryngoscopy, the use of a stylet is strongly advised to deliver the endotracheal tube (ETT) to the glottis. Unlike Doyle and colleagues, I configure the stylet to the same shape of the GlideScope® blade (approximately a 60° bend). In our series, most failures resulted from difficulty inserting the blade into the patient’s mouth or the inability to deliver the ETT to a visualized glottis.
As stated by Dr. Doyle, Agrò and colleagues’ interesting article1 had not been submitted at the time my report2 was accepted for publication. These authors have demonstrated the utility of the GlideScope® to improve laryngeal exposure and facilitate tracheal intubation in patients with simulated cervical immobilization.
References
1 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.
2 Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.
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