Combined application of GlideScope video laryngoscope and fiberoptic bronchoscope for double-lumen en-dobronchial tube intubation in patients with difficult glottis exposure / 临床麻醉学杂志

Objective To explore the clinical application of GlideScope video laryngoscope combined with fiberoptic bronchoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure.Methods Forty patients undergoing scheduled for thoracic surgery (24 males,1 6 females,aged 24-78 years,falling into ASA Ⅰ or Ⅱ,Mallampati classification Ⅲ or Ⅳ, were randomly divided into two groups (n=20 each):GlideScope video laryngoscope combined with fiberoptic bronchoscope group (group GF)and Macintosh laryngoscope group (group M).In group GF,GlideScope video laryngoscopy combined with fiberoptic bronchoscope was used to guide the double-lumen tube bronchial intubation and then bronchoscope was used to check the placement of the tube.In group M,the double-lumen endobronchial tube was intubated with conventional macintosh laryngoscope,and then the placement of the tube was checked by bronchoscope.The results of the Cormack and Lehane grade measuring the degree of glottic opening during laryngoscopy,the intuba-tion time consumed,one-time intubation success rate,patients manoeuvre needed to aid tracheal intu-bation and endotracheal intubation related complications within 48 hours after operation were recorded and compared between the two groups.Results Compared with group M,the Cormack and Lehane grade was significantly better (P < 0.01 ), intubation time consumed was significantly shorter [(104.3±1 1.1)s vs.(138.6 ± 33.0)s](P < 0.01 ),one-time intubation success rate was higher (90% vs.55%)(P <0.05 ),fewer patients needed manoeuvre to aid tracheal intubation (20% vs. 90%)(P < 0.01 )and postoperative complications of hoarseness and pharyngalgia within 48 hours were significantly fewer (5% vs.35%,25% vs.75%)in group GF(P <0.05 ).Conclusion Com-pared with conventional method, GlideScope video laryngoscope combined with fiberoptic bronchoscope used to guide double-lumen endobronchial tube intubation in patients with difficult glottis exposure may improve the success rate of intubation,reduce the stress response of intubation and postoperative complications of hoarseness and pharyngalgia.

Acute traumatic injury and delayed airway obstruction after the use of a GlideScope in a patient with a difficult airway: A case report

Endotracheal intubation sometimes leads to complications, particularly in patients with anticipated difficult intubation. The GlideScope is preferred because of its high success rate in cases with anticipated difficult intubation. However, complications during the process have been reported. Most minor injuries can be treated after early detection. However, treatment can be difficult if complications occur later. We report a patient who underwent an emergency tracheostomy due to a delayed airway obstruction caused by pharyngeal wall bleeding during intubation with a GlideScope.

Comparison of Disposcope endscope and GlideScope vedio laryngoscope in the application of double-lumen endobronchial intubation in difficult airway / 临床麻醉学杂志

Objective To evaluate and compare the clinical applications of Disposcope (DS)en-doscope and GlideScope (GS)video laryngoscope in double-lumen endobronchial tube (DLT)intuba-tion of the patients with difficult airway.Methods Forty patients scheduled for elective thoracic sur-gery after failure to place the DLT with modified general laryngoscope 2 attempts were randomly dev-ided into 2 groups,20 cases in each group.Patients underwent DLT with DS (group DS)or GS (group GS)intubation after failure to intubation.The causes of the failure of intubation,the intuba-tion of the video laryngoscope,the time of intubation and the location of left double lumen tube were recorded.And the postoperative injury of oral mucosa,teeth and respiratory tract were observed. Results The causes of the difficulty for DLT intubation included:long,high arched palate,large epi-glottis,reduced jaw opening,protruding or loose incisors,over bite,reduced neck extension.The in-tubating achievement ratio was significantly higher in group DS than in group GS (P < 0.05 ).But there was no obvious difference between the two groups in the location success rate and intubation time.The postoperative incidence of tooth loss and oral mucosal injury was significantly higher in group GS than in group DS (P <0.05).Conclusion Both DS and GS were great helpful to intubation and location of DLT in the patients with difficult airway.But DS was more superior than that of GS in the difficult airway of reduced jaw opening,protruding or loose incisors,over bite and reduced neck extension.

Factors Related to Successful Endotracheal Intubations with Glidescope(R)

PURPOSE: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. METHODS: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. RESULTS: A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). CONCLUSION: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.

A comparison of the Glidescope(R) to the McGrath(R) videolaryngoscope in patients / 대한마취과학회지

BACKGROUND: The Glidescope(R) videolaryngoscope is a new device for tracheal intubation that provides an improved view of the larynx. This study was performed to compare the Glidescope with the McGrath videolaryngoscope in terms of time to intubation (TTI) and number of attempts. METHODS: Patients were randomly allocated to one of two groups, Glidescope or McGrath group, by using computer-generated numbers. Tracheal intubation was attempted by an anesthesiologist with extensive experience using these two devices. The operator recorded ease of visualization of glottic structures based on the classification described by Cormack and Lehane. Number of failures, number of attempts and their duration, total intubation time, and events during the whole procedure were recorded. The duration of one attempt was defined as the time elapsed between picking up the endotracheal tube and verification of tracheal intubation with visualization of three expiratory carbon dioxide waveforms. TTI was defined as the sum of the duration of all intubation attempts (as many as three), excluding preoxygenation procedures. RESULTS: TTI was significantly shorter for the Glidescope(R) compared to the McGrath(R) laryngoscope (40.5 vs. 53.3 s, respectively, P < 0.05). However, glottic views obtained at intubation were similar between the two groups. Number of intubation attempts was not significantly different between the two groups (1.03 +/- 0.19 vs 1.10 +/- 0.32, respectively) (mean +/- SD). CONCLUSIONS: Study results demonstrated that the Glidescope reduced total intubation time in comparison with the McGrath, in terms of TTI in patients with normal airways.

A comparative study on the usefulness of the Glidescope or Macintosh laryngoscope when intubating normal airways / 대한마취과학회지

BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways.

Awake Glidescope(R) intubation in a patient with a huge and fixed supraglottic mass: A case report / 대한마취과학회지

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.

A Comparison-study of the Effects of Conventional and Video Laryngoscopic Intubation on Heart Rate and Blood Pressure / 대한마취과학회지

BACKGROUND: Glidescope(R) is a video-assisted intubation device.It offers a clear view and is easy to use, giving it several advantages over conventional intubation devises.This study was designed to compare the hemodynamic effects and POGO scores between conventional and video laryngoscopic intubation. METHODS: Sixty adult patients with ASA 1 or 2 were randomly allocated into two groups; Glidescope(R) (group G) or Macintosh (group M).Anesthesia was induced with propofol and remifentanil.Blood pressure and heart rate were recorded just prior to intubation and 1, 3, and 5 minutes after intubation.POGO scores, intubation time and the severity of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, POGO score, intubation time and the severity of sore throat between two groups. CONCLUSIONS: The POGO scores and hemodynamic changes associated with tracheal intubation using the Glidescope(R) were almost the same as that of the Macintosh group.

Application of GlideScope~ in anesthetic endotracheal intubation / 上海第二医科大学学报

Objective To evaluate the clinical application of GlideScope~ video laryngoscope in anesthetic endotracheal intubation.Methods Two hundred patients who received surgery under general anesthesia with ASA I or II were involved in this study.One hundred patients were assigned to be intubated with GlideScope~(GS group) and the other 100 with size 3 Macintosh laryngoscope(ML group).The following data were recorded and analyzed: noninvasive blood pressure(NBP),heart rate(HR) at the different time points of intubation process,glottic exposure time,CormarkLehane grade,tracheal intubation time and total intubation attempts. Results The rise of NBP and HR in ML group were significantly higher than those in GS group(P

Application of Glidescope Video-Laryngoscope in Children Undergoing General Anesthesia / 实用儿科临床杂志

0.05).The Cormack and Lehane laryngeal exposure grades obtained by the Macintosh laryngoscope with and without ELM were significantly different(Z=3.55 P0.05).Of all 33 pediatric patients,successful orotracheal intubation using the GSLV was completed by one attempt in 31 patients and by 2 attempts in 2 cases.The time required to achieve successful tracheal intubation was 20-51(30.0? 7.9) s.Conclusions GSLV is as useful as Macintosh laryngoscope for laryngeal exposure and orotracheal intubation in children.When the orotracheal intubation is done using the GSLV in children,the distal end of a styletted endotracheal tube should be bent anteriorly to an angle of 70-80 degrees and ELM is routinely used.