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Canadian Journal of Anesthesia 53:423-424 (2006)
© Canadian Anesthesiologists' Society, 2006

Correspondence

The GlideScope® video laryngoscope: initial experience in five neonates

Daniele Trevisanuto, MD*, Enrica Fornaro, MD* and Chandy Verghese, MD{dagger}

* University of Padova, Azienda Ospedaliera di Padova, Padova, Italy
{dagger} Royal Berkshire Hospital National Health Service Trust, Reading, United Kingdom, E-mail: trevo{at}pediatria.unipd.it

To the Editor:

The GlideScope® video laryngoscope (GVL; Saturn Biomedical Systems, Burnaby, BC, Canada) is a relatively new intubating device.1–3 The greatest reported experience with the GVL is in adult patients.1,3 We recently used the neonatal model GVL in five neonates presenting for elective nasotracheal intubation (NTI). Demographics are reported in the TableGo. Nasotracheal intubation was performed by two pediatric residents supervised by an expert neonatologist. In accordance with our local protocol, fentanyl 2 µg·kg–1 iv was administered to all patients prior to NTI.


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  		TABLE Experience with GlideScope® for tracheal intubation in neonates
 
Intubation with GVL was successful in three of the five cases (cases 1, 2, 5). In cases 3 and 4, NTI was performed by direct laryngoscopy after two failed attempts with the GVL. In case 1, a good view of the glottis was obtained and the tracheal tube (TT) was passed without difficulty. In the remaining four patients, the view of the glottis was very limited, including cases 2 and 5, and several other problems were encountered. Although airway images had excellent definition, "fogging" occurred to a greater or lesser degree, limiting the view of the pharynx and larynx.2 A second limitation specific to the neonatal population relates to the special curvature of the GVL blade that appears to cause resistance to the advancement of the TT.3 In case 1, this difficulty was overcome by repositioning the blade inside the mouth. In the smaller neonates, this procedure was not possible because the blade in which the camera was installed was blocked by the small size of the mouth. As the length and the width of the blade were inadequate for this group of preterm infants, development of a smaller version, suitable for neonatal use, may be warranted.

The two main advantages of the GVL, when compared to standard laryngoscopes, are an improved view of the larynx facilitating successful tracheal intubation, and a potential role for teaching purposes.3–5 While these aspects are important for personnel dedicated to adults patients, they could assume equal, if not greater, potential importance for physicians involved in the care of the neonatal airways.

Finally, we noticed that the position of the operator using GVL is different from operator positioning for direct laryngoscopy. The orientation of the videochip imparts a different laryngoscopic view as compared to that seen when simultaneously looking into the mouth.4 Our experience suggests the requirement for operator training with this new instrument before routine use. On a positive note, the manipulations of the GVL by the resident, and the observed effect of these manipulations on the position of the blade tip on the GVL display and passage of the TT made it a valuable teaching device. The verbal instructions to the resident were also helpful to attending observers.

In conclusion, we feel that the GVL could become an effective device for neonatal intubation. However, the neonatal model GVL we used was not entirely satisfactory in the neonatal population. This group of patients may well benefit from further refinements of the GVL specifically designed for neonatal use.

Footnotes

Accepted for publication December 5, 2005.

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 2005; 60: 94–381.

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

3 Rai MR, Dering A, Verghese C. The GlideScope® system: a clinical assessment of performance. Anaesthesia 2005; 60: 60–4.[Medline]

4 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]

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




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