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Correspondence |
Thomas Jefferson University Hospital, Philadelphia, USA, E-mail: james.heitz{at}Jefferson.edu
To the Editor:
We read with great interest the letter from Dupanovic et al.1 regarding the optimal shape of the endotracheal tube for endotracheal intubation with the GlideScope® video laryngoscope (GSVL) (Saturn Biomedical Systems, Burnaby, BC, Canada). As previously identified, a frequently encountered difficulty with the GSVL lies in passing the endotracheal tube, not necessarily in obtaining a good view of the glottis.1–4 In one series of 728 patients, the intubation failure rate of the GSVL was 3.7%, despite the ability to obtain a good or excellent view of the glottis in the majority of the cases.2 In our practice, we have found that a J-shaped endotracheal tube, formed to follow the contour of the GlideScope, facilitates the most rapid intubation (Figure
). By following the contour of the GSVL and allowing approximately 1 cm of tube to extend beyond the end of the scope, we have increased our success rate and time of airway instrumentation compared to the use of an endotracheal tube with a single 60° bend, as described in the operator’s manual.5 We occasionally use two lubricated stylets simultaneously (Shore Medical Safety Stylet Endotracheal Tube Guide, Orange, CA, USA) to increase the stiffness of the preformed endotracheal tube. This maneuver is similar to using the firm 5.6 mm stylet described by Cuchillo et al.4 The increased stiffness is helpful in situations when the endotracheal tube loses angulation when passing between the GSVL and the tonsillar pillar. It should be noted that an additional 90° bend applied to the proximal end of the endotracheal tube frequently facilitates placement by preventing it from impacting on the chest during advancement of the tube into the pharynx.
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Footnotes
Accepted for publication March 8, 2006.
References
1 Dupanovic M, Diachun CA, Isaacson SA, Layer D. Intubation with the GlideScope® videolaryngoscope using the "gear stick technique" (Letter). Can J Anesth 2006; 53: 213–4.
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. Videolaryngosopy in the management of the difficult airway (Letter, reply). Can J Anesth 2004; 51: 95.
4 Cuchillo JV, Rodriguez MA. Considerations aimed at facilitating the use of the new GlideScope® videolaryngoscope (Letter). Can J Anesth 2005; 52: 661.
5 GlideScope® Video Intubation System. Operator & Service Manual, Saturn Biomedical Systems, Inc., Burnaby, BC, Canada.
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