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Canadian Journal of Anesthesia 53:1263-1264 (2006)
© Canadian Anesthesiologists' Society, 2006

Correspondence

The StyletScope® facilitates tracheal intubation with the GlideScope®

Yoshihiro Hirabayashi, MD

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

To the Editor:

The GlideScope® (Diagnostic Ultrasound Corporation, Bothell, WA, USA) is a videolaryngoscope that could have a profound impact on clinical airway management. The flange of the blade has a 60° angle, resulting in a better exposure of the larynx than traditional Macintosh blades.1 However, one limitation of the device is that the flange of the blade is angled in such a way that it may be difficult, or occasionally impossible, to pass the endotracheal tube (ETT) through the glottis, despite complete visualization of the glottis.2–4 Glottic exposure is likely to elevate the glottis anteriorly, requiring a steeper curve of the styletted-ETT. This increases the angle between the axis of the ETT tip and the tracheal axis. The tip of the ETT sometimes collides with either the anterior commissure of the glottis or the anterior wall of the cricoid cartilage, preventing advancement of the ETT into the trachea. Several maneuvers may resolve this "hesitation of the tube":

  1. relaxing the elevation of the laryngoscope;5
  2. withdrawal of the laryngoscope 1–2 cm;5
  3. withdrawal of the stylet approximately 4 cm;5 and
  4. clockwise rotation of the ETT.4

When these maneuvers fail, we used the StyletScope® (Nihon Kohden Co., Tokyo, Japan). This device has a flexible tip stylet, the angle of which is completely controlled by the power of a handgrip (FigureGo). The angle of the ETT tip can be adjusted between 30° and 90°. Once a satisfactory view of the glottis is obtained on the monitor screen of the GlideScope®, while gripping the handle of StyletScope® strongly, the tip of the ETT is delivered to the glottis (Figure AGo). A slight release of the handgrip makes the ETT tip face downward, resulting in alignment of the axis of the ETT tip with the tracheal axis (Figure BGo). Once the two axes are aligned, the ETT is advanced through the glottis, and into the trachea (Figure CGo). This maneuver avoids impacting the ETT tip on the anterior commissure of the glottis or the anterior wall of the cricoid cartilage. Finally, while fully releasing the handgrip, the StyletScope® is smoothly extracted from the ETT. This procedure has been very helpful in managing tracheal intubations with GlideScope® at our institution.


Figure 1
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  		FIGURE Left) Laryngeal exposure and the distal tip of the endotracheal tube (ETT). Right) The StyletSccope® with an ETT. A) The handgrip is held forcibly with the ETT tip facing upwards at 90°. The tip of the ETT collides with the anterior commissure of the glottis. B) A slight release of the handgrip can adjust the ETT tip to bend at a favourable angle. The axis of the ETT tip is aligned with the axis of the trachea; this avoids impacting the ETT tip on the anterior commissure of the glottis or the anterior wall of the cricoid cartilage. Note the space in the anterior portion of the glottic orifice (arrow). C) Full-release of the handgrip provides smooth removal of the StyletScope® from the intubated-ETT.

 

Footnotes

Accepted for publication September 19, 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 Rai MR, Dering A, Verghese C. The Glidescope® system: a clinical assessment of performance. Anaesthesia 2005; 60: 60–4.[Medline]

3 Cuchillo JV, Rodriguez MA. Consideration aimed at facilitating the use of the new GlideScope® videolaryngoscope (Letter). Can J Anesth 2005; 52: 661–2.[Free Full Text]

4 Cooper RM. Consideration aimed at facilitating the use 1263 of the new GlideScope® videolaryngoscope (Letter, reply). Can J Anesth 2005; 52: 661–2.[Free Full Text]

5 GlideScope® Video Intubation System. System Operation & Service Manual. Saturn Biomedical Systems Inc., Burnaby, BC, Canada; 2003.





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