A New Use for the GlideScope

Abstract

To the Editor: We report a case in which we used the GlideScope to successfully place a nasogastric tube after all other placement methods had failed. Our 63-yr-old male patient had undergone a right hemicolectomy 2 wk before admission. He presented to the emergency room with a 2-day history of distended abdomen and absence of defecation. The patient was scheduled for an emergent exploratory laparotomy. On arrival in the operating room, he complained of intense abdominal pain and discomfort secondary to abdominal distention. The patient’s airway was classified as Mallampati I, and he was edentulous. We quickly and easily induced anesthesia and intubated the trachea in rapid sequence. We tried and failed several times to place a nasogastric tube, including digitally manipulating its tip and visualizing the posterior oropharynx with Macintosh and Miller blades. Once the GlideScope was brought to the operating room, we easily placed the short GlideScope blade in the pharynx and obtained a clear view of the laryngeal structures and the entrance to the esophagus. We lifted the epiglottis with the GlideScope’s tip and advanced the nasogastric tube manually into the esophagus. The position was verified by surgical palpation in the stomach and return of gastric fluid when aspirated. The GlideScope is designed to assist with challenging intubations by providing a video view of the larynx during intubation. One can master using the GlideScope with a few attempts. The GlideScope adds to our available techniques for passing intransigent orogastric tubes. Christine W. Hunter, MD Shaul Cohen, MD Department of Anesthesia University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School New Brunswick, NJ [email protected]