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GlideScope® videolaryngoscope facilitates nasotracheal intubation

Jichi Medical University, Tochigi, Japan, E-mail: yhira{at}jichi.ac.jp

To the Editor:

Increasing evidence indicates the emerging role of GlideScope® videolaryngoscope (Diagnostic Ultrasound Corporation, Bothell, WA, USA) for both routine and difficult airway management.^1–5 We recently undertook a clinical evaluation of GlideScope® videolaryngoscopy (GV) to test its effectiveness for nasotracheal intubation performed by residents in training, comparing it with direct laryngoscopy (DL) using a #3 or #4 Macintosh blade and Magill forceps. After obtaining Ethics Committee approval, we studied 20 patients who required nasotracheal intubation for surgical convenience. After induction of anesthesia and establishing mask ventilation, a pre-warmed, lubricated endotracheal tube (Polar preformed tracheal tube, Portex Inc., Keene, NH, USA) was introduced into either the right or left nares, and either GV (n = 10) or DL (n = 10) was performed. Patients were randomly assigned to either group and allocation concealment was established using sealed envelopes. Under direct visualization, the laryngoscopist directed the tube tip into the glottis. If the tube could not be inserted into the glottis, Magill forceps were used to grasp the tube while an assistant advanced the tube by pushing on the nasal end. Each intubation was performed by trainees who had one to two months of training in airway management.

Patients in the two groups were comparable with respect to age, weight and height. Nasotracheal intubation was achieved in 45 ± 13 (range 30–65) sec in group GV, while it required 114 ± 37 (range 60–195) sec in group DL with Magill forceps (P < 0.001, Student’s t test).

The time required for nasotracheal intubation is highly operator-dependent. The trainees participating in this study were non-anesthesia residents, and hence the times to establish the airway were long using the DL approach. Despite this observation, there were no adverse events or episodes of oxygen desaturation. We did observe that an unobstructed view of the glottic opening on the videolaryngoscope monitor helped the laryngoscopist performing the nasal endotracheal intubation, while an assistant provided laryngeal manipulation to improve the coordinated effort. Accordingly, videolaryngoscopy may serve an important role in teaching nasotracheal intubation. In addition, Magill forceps were not needed for any patient using GlideScope® videolaryngoscopy, while DL required Magill forceps utilization for all patients. Finally, with inexperienced operators, it is not uncommon to have some degree of difficulty in grasping the tube with the Magill forceps while avoiding trauma to the cuff. This problem appears to be obviated by GV. It is concluded that the GlideScope® videolaryngoscope facilitates nasotracheal intubation for individuals training in airway management.

Footnotes

Accepted for publication August 10, 2006.

References

1 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.[Abstract/Free Full Text]

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

3 Doyle DJ. Awake intubation using the GlideScope® video laryngoscope: initial experience in four cases (Letter). Can J Anesth 2004; 51: 520–1.[Free Full Text]

4 Doyle DJ. GlideScope®-assisted fiberoptic intubation: a new airway teaching method. Anesthesiology 2004; 101: 1252.[Medline]

5 Lim Y, Yeo SW. A comparison of the GlideScope® with the Macintosh laryngoscope for tracheal intubation in patients with simulated difficult airway. Anaesth Intensive Care 2005; 33: 243–7.[Medline]

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This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hirabayashi, Y. Search for Related Content PubMed PubMed Citation Articles by Hirabayashi, Y.