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Correspondence |
Hospital General de Castellón, Castellón, Spain E-mail: chelo.quique{at}tiscali.es
To the Editor:
While recognizing the emerging role of the GlideScope® (Saturn Medical, Burnaby, BC, Canada) for both routine and difficult airway management,1–5 a persistent limitation of the device is that the videolaryngoscope blade is angled in such a way that it may be difficult, or occasionally impossible to pass the endotracheal tube (ETT) through the glottis. In an attempt to solve this problem and facilitate intubation, accessories such as the Mallinckrodt Satin-Slip® Intubating Stylet (Tyco Healthcare Group LP, Pleasanton, CA, USA) and the Parker Flex-It-Stylet (Parker Medical, Englewood, CO, USA) have been developed. Our team uses the GlideScope together with a new accessory, the modified Eschmann guide. The conventional guide consists of a flexible 0.5 cm x 50 cm stylette with a 45° distal angle. It is a non-traumatic guide made of woven polyester with a resin coating that provides strength and flexibility at body temperature. Because of its elastic properties, however, the conventional guide tends to resume its linear form shortly after it has been configured to patient requirements. The modified guide solves this problem satisfactorily. Its dimensions and characteristics are similar to those described above, but instead of a hollow design it includes a 1-mm steel wire core that provides the device with a memory feature, making it retain its desired shape during manipulation in the oropharynx. The anesthesiologist can thus shape the guide by curving it into the most suitable configuration to achieve glottic access. Once access to the glottis is achieved, the ETT easily slides over the guide during visualization with the videolaryngoscope. After entering the trachea with the distal tip of the ETT, the guide is removed. During removal, the guide slides back within the walls of the ETT and resumes its initial shape, behaving like a conventional elastic element that facilitates smooth extraction.
We recently undertook a clinical evaluation of this new device to test its effectiveness. After obtaining Ethics Committee approval, a group of five anesthesiologists experienced with the GlideScope and the modified guide for endotracheal intubation (ETI), studied this device in 40 randomly selected surgical patients. Of the 40 patients, five had a thyromental distance of less than 6 cm; six had a sternomental distance of less than 12 cm; three had a body mass index of more than 35; and three had limited cervical extension. On the Mallampati scale, 16 patients were grade I; 15 were grade II; eight were grade III; and one was grade IV.
Following induction of anesthesia, ETI was achieved in less than 60 sec in 38 patients (95%). In the two remaining cases (5%), in which the initial curve of the guide had to be modified, ETI was achieved in 120 and 180 sec respectively. Although this is a limited series, no failures were experienced.
The ease of use of the GlideScope and its ability to provide visualization of the glottis, which equals or exceeds that of conventional laryngoscopy, make it a very useful tool for ETI. Our proposed use of the modified guide provides a simple, economical, and non-traumatic approach to ETI.
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Accepted for publication March 1, 2006.
References
1 Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.
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, Ramachandran M. Videolaryngoscopy in the management of the difficult airway (Letter). Can J Anesth 2004; 51: 95.
4 Doyle DJ. GlideScope-assisted fiberoptic intubation: a new airway teaching method (Letter). Anesthesiology 2004; 101: 1252.[Medline]
5 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.
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