| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Correspondence |
Toronto General Hospital and University of Toronto, Toronto, Canada, E-mail: richard.cooper{at}uhn.on.ca
I am grateful for the opportunity of responding to the interesting letter from Drs. Cuchillo and Rodriguez.
Two recent publications are consistent with their comment that this device frequently provides comparable, but more frequently superior laryngeal exposure than direct laryngoscopy.1,2 However, it may be difficult to introduce the laryngoscope blade into the mouths of patients with limited atlanto-occipital extension, reduced interincisor distance and/or a very protuberant chest. Their suggestion of introducing the laryngoscope upside down and rotating it as with a Guedel airway has not been previously described, and may prove helpful.
I am surprised by their comment concerning a foggy image. The transparent glass protecting the videochip is heated to eliminate condensation. There should be no need to warm the instrument nor should anti-fogging solutions be required. In well over 500 GlideScope® laryngoscopies, I have never experienced any fogging. This leads me to question whether their device has been damaged.
I believe that the last point raised by Drs. Cuchillo and Rodriguez really has two components, namely difficulty in delivering the endotracheal tube (ETT) to the glottis though easily seen, and passage of the ETT into the trachea. Regarding the delivery problem, some frequent users have successfully adapted different stylet configurations. At present, we do not know whether our recommended 60° configuration,2 Doyle’s 90°,3 or Arndt’s U-shapeA produces the best results. It has been my experience that insertion of both the GlideScope® videolaryngoscope and the styletted-ETT in the midline generally results in correct alignment. This may, however, result in a significant angle of incidence between the laryngeal axis and the ETT. Several strategies may prove helpful: i) relaxing the elevation of the laryngoscope; ii) slight withdrawal of the laryngoscope; iii) applying external laryngeal pressure to depress the laryngeal inlet; and iv) insertion of a cudé-tipped gum elastic bougie and subsequent railroading of the ETT, both performed under visual control. The second problem, namely difficulty advancing the ETT, may be corrected by the above techniques that diminish the angle of incidence or the rotation that Cuchillo and Rodriguez (and Cooper)4 described. Alternatively, the styletted-ETT can be shaped as above, however in a direction opposite to the inherent memory of the ETT. Removal of the stylet will then result in the tube migrating upward, as if rotation had been performed.
Footnotes
Dr. Cooper is a consultant to Saturn Biomedical Systems.
A Arndt G. Unpublished abstract, Society for Airway Management, Chicago, IL, USA, September, 2004. 
References
1 Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope® Video Laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2004; aei041.
2 Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope®) in 728 patients. Can J Anesth 2005; 52: 191–8.
3 Doyle DJ, Zura A, Ryckman VJ. Awake intubation using the Glidescope® Video Laryngoscope: a series of 20 cases. Anesthesiology 2004; 101: A520 (abstract).
4 Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.
Related articles in CJA:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
