A comparison of glidescope videolaryngoscopy to direct laryngoscopy for nasotracheal intubation.

BACKGROUND: In this study, we compared the effectiveness of direct laryngoscopy (DL) and the GlideScope videolaryngoscope (GVL) for nasotracheal intubation, as judged by the time to intubation (TTI-the primary outcome) and the ease of intubation. METHODS: Seventy patients requiring nasotracheal intubation for elective surgery were randomly allocated to intubation with the GVL or DL. TTI was assessed by a blinded observer. Operators were blinded until the start of laryngoscopy. A Visual Analog Scale assessed the ease of intubation. The number of intubation attempts, number of failures, glottic grades, amount of bleeding, usage of Magill forceps, and the severity of postoperative sore throat were recorded. RESULTS: The median TTI was 23.2 s faster with the GVL (43.5 s, interquartile range [IQR]: 39.8-67.3) than with DL (66.7 s, IQR: 53.8-89.9), P = 0.0023. Nasotracheal intubation was easier with the GVL than with DL (Visual Analog Scale 10 mm, IQR: 5.5-18, vs 20 mm, IQR: 10-32, P = 0.0041). The incidence of postoperative moderate or severe sore throat was significantly reduced in the GVL group (9% vs 34%, P = 0.018). Glottic exposure was significantly better with the GVL. Magill forceps were not used in the GVL group, but were used 49% of the time in the DL group, P < 0.0001. The incidence and severity of bleeding were similar between groups. CONCLUSIONS: Compared with DL, the GVL has superior performance characteristics when used for nasotracheal intubation and demonstrates an important reduction of postoperative sore throat. The GVL has a clear role in routine nasotracheal intubation.

The GlideScope-specific rigid stylet and standard malleable stylet are equally effective for GlideScope use.

PURPOSE: The GlideScope videolaryngoscope usually provides excellent glottic visualization, but directing an endotracheal tube (ETT) through the vocal cords can be challenging. The goal of the study was to compare the dedicated GlideScope-specific rigid stylet to the standard malleable stylet, assessed by time to intubation (TTI). METHODS: Eighty patients requiring orotracheal intubation for elective surgery were randomly allocated to either the GlideScope rigid stylet (GRS) or a standard malleable stylet to facilitate intubation using the GlideScope. Time to intubation was recorded by blinded assessors; operators were blinded until after laryngoscopy. The operator assessed the ease of intubation using a visual analogue scale (VAS). The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were documented. RESULTS: The median TTI was 42.7 sec (inter-quartile range (IQR) 38.9-56.7) for the GRS group compared to 39.9 sec (IQR 34.1-48.2) for the control group (P=0.07). The median VAS score for ease of intubation was 20 (IQR 12.0-33.0) for the GRS group compared to 18 (IQR 9.5-29.5) for the control group (P=0.21). There was no significant difference in TTI or VAS between stylets. The overall incidence of a Cormack-Lehane grade I or II glottic view was 98%. CONCLUSIONS: In a group of experienced operators using the GlideScope, the dedicated GRS and the standard malleable ETT stylet are equally effective in facilitating endotracheal intubation.

Effect of stylet angulation and endotracheal tube camber on time to intubation with the GlideScope.

PURPOSE: The GlideScope videolaryngoscope usually provides excellent glottic visualization, but directing an endotracheal tube (ETT) through the vocal cords is sometimes difficult. The goal of the study was to determine which of two ETT angles (60 degrees vs 90 degrees ) and cambers (forward vs reverse) was better, as determined by time to intubation (TTI). METHODS: Two hundred patients requiring orotracheal intubation for elective surgery were randomly allocated to one of four groups: A) 90 degrees angle, forward camber; B) 90 degrees angle, reverse camber; C) 60 degrees angle, forward camber; D) 60 degrees angle, reverse camber. Time to intubation was assessed by a blinded observer. Operators were blinded until the point of intubation. A visual analogue scale (VAS) assessed the ease of intubation. The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were recorded. RESULTS: The angle of the ETT had an impact on TTI but camber did not. The 90 degrees angle demonstrated a 13% faster TTI than the 60 degrees angle (47.1 +/- 21.2 sec vs 54.4 +/- 28.2 sec, P=0.042), and it resulted in easier intubation (VAS 16.4 +/- 14.2 mm vs 27.3 +/- 23.5 mm, P=0.0001). The overall incidence of a grade 1 or 2 Cormack-Lehane glottic view was 99%. CONCLUSIONS: In a heterogeneous group of operators and patients intubated with the GlideScope, a 90 degrees ETT angle provided the best result and should be the initial configuration. The camber of the ETT does not affect the time to intubation.