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 Kramer, D. C. Articles by Osborn, I. P. Search for Related Content PubMed PubMed Citation Articles by Kramer, D. C. Articles by Osborn, I. P.

More maneuvers to facilitate tracheal intubation with the GlideScope®

Mount Sinai Medical Center, New York, USA, E-mail: david.kramer{at}msnyuhealth.org

To the Editor:

The GlideScope® (Diagnostic Ultrasound Corporation,Bothell, WA, USA), is a videolaryngoscope, whichincorporates a fibreoptic and digital camera systeminto the blade.¹ The blade displays a video output to adedicated monitor. The flange of the blade has a 60°angulation, which facilitates better exposure of the larynxthan traditional Macintosh blades.^2,3 Some authorshave reported difficulty intubating the trachea despitethe superior view offered by the GlideScope®.¹ In thelargest series of Glidescope use (728 patients), 14 ofthe 26 failed intubations occurred in spite of achievinga Cormack-Lehane grade 1 view.⁴ In that study,failures resulted not from an inability to view the larynx,but in directing the endotracheal tube throughthe glottic opening. In our experience, the device hasbeen successful in over 500 patients, especially thosewith large tongues, relatively small mouths, and inpatients with limited neck mobility. We have used thedevice for conventional induction, in rapid sequenceintubation, and for awake intubation. Because theGlideScope lifts the tongue rather than displacing itinto the submental space, patients with Mallampaticlass III and IV airways are usually afforded Cormack-Lehane grades 1 or 2 glottic views.

We have found the following maneuvers to be helpfulwhen intubating the trachea with the GlideScope®:

1. Using a stylette, bend the endotrachealtube (ETT) into a "hockey stick" shape; thisusually facilitates tracheal intubation if oneobtains a Cormack-Lehane grade 1 view. Ifthe larynx appears anteriorly, bending the ETTinto a steeper curve is helpful. This can beachieved by emulating the bend of theGlideScope® flange and handle.
   
2. Introduce the ETT through the mouth in ahorizontal plane, and once the tube has passedthe flange of the GlideScope®, rotate the ETTto the vertical position.
   
3. If the ETT advances posteriorly to the arytenoids, the following is helpful: With the ETTheld between the fingertips, pull it superiorly,rotate the ETT over the left arytenoid, and gently twist the tube over the epiglottic aperture.
   
4. If the ETT abuts the glottic lip, rotate the ETTclockwise into the glottic aperture, while with-drawing the stylet.⁵
   

A midline approach and positioning to achievean optimal laryngeal view is also important. Thedescribed maneuvers have helped the authors facilitateintroduction of the ETT into the mouth, past theGlideScope®, and decrease the risk of trauma to theposterior larynx and tracheal glottis. These approacheshave also been very helpful in teaching proper useof the GlideScope®, and in managing failed trachealintubations at our institution.

Footnotes

Accepted for publication March 20, 2006.

References

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

2 Hsiao WT, Lin YH, Wu HS, Chen CL. Does a newvideolaryngoscope (GlideScope) provide better glotticexposure? Acta Anaesthesiol Taiwan 2005; 43: 147–51.[Medline]

3 Lim TJ, Lim Y, Liu EH. Evaluation of ease of intubationwith the GlideScope or Macintosh laryngoscopeby anaesthetists in simulated easy and difficult laryngoscopy.Anaesthesia 2005; 60: 180–3.[Medline]

4 Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Earlyclinical experience with a new videolaryngoscope(GlideScope) in 728 patients. Can J Anesth 2005; 52:191–8.[Abstract/Free Full Text]

5 Cuchillo JV, Rodriguez MA. Considerations aimed atfacilitating the use of the new GlideScope videolaryngoscope(Letter). Can J Anesth 2005; 52: 661.737[Free Full Text]

This article has been cited by other articles:

				P. Cortellazzi, L. Minati, C. Falcone, M. Lamperti, and D. Caldiroli Predictive value of the El-Ganzouri multivariate risk index for difficult tracheal intubation: a comparison of Glidescope(R) videolaryngoscopy and conventional Macintosh laryngoscopy Br. J. Anaesth., December 1, 2007; 99(6): 906 - 911. [Abstract] [Full Text] [PDF]

				P. Cross, J. Cytryn, and K. K. Cheng Perforation of the soft palate using the GlideScope(R) videolaryngoscope Can J Anesth, July 1, 2007; 54(7): 588 - 589. [Full Text] [PDF]

				W.-T. Hsu, S.-C. Hsu, Y.-L. Lee, J.-S. Huang, and C.-L. Chen Penetrating Injury of the Soft Palate During GlideScope(R) Intubation Anesth. Analg., June 1, 2007; 104(6): 1609 - 1610. [Full Text] [PDF]

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 Kramer, D. C. Articles by Osborn, I. P. Search for Related Content PubMed PubMed Citation Articles by Kramer, D. C. Articles by Osborn, I. P.