GlideScope versus a direct laryngoscope for nasotracheal intubation in oral and maxillofacial surgery patients with anticipated difficult airways

Abstract

Background Ideally, an airway for a surgical procedure should be secured with the method that offers the greatest safety, the most efficiency, and the least morbidity. General anesthesia for oral and maxillofacial surgery is one of the most challenging tasks for an anesthetist. Nasotracheal intubation is usually required in these patients to allow an unrestricted surgical approach. It poses an interesting problem, particularly when associated with difficult airways. The GlideScope video-laryngoscopy (GVL) appears to provide better glottic visualization than direct laryngoscopy. However, the effectiveness of GlideScope for nasotracheal intubation in patients for oral or maxillofacial surgery with difficult airways requires more investigation. The aim of this study is to evaluate the usefulness of GVL versus a direct laryngoscope for nasotracheal intubation in adult patients with difficult airways presenting for oral or maxillofacial surgery. Patients and methods In this study, the Macintosh laryngscope and the Glidescope were compared for nasotracheal intubation in 40 patients ASA I–III with difficult airways undergoing oral or maxillofacial surgery. The patients were randomly assigned to a laryngoscopic group (DL group) or a Glidescope group (GV group). Before nasotracheal intubation, all patients were given a Cormack and Lehane (C&L) grade by a separate anesthetist using a Macintosh laryngoscope. The patients were then intubated using direct laryngoscopy or the GlideScope. Outcome measures included grading of view, the success or failure of intubation, numbers of intubation attempts, time to intubation, usage of Magill forceps, and complications. Results There were no differences between groups with respect to hemodynamic and oxygen saturation during the study period, P greater than 0.05. There was a significant difference in laryngoscopic views according to the C&L classification. The C&L I and II views obtained by the conventional laryngoscope increased from 70 to 95% of cases with the GlideScope ( P P less than 0.05. The intubation was successful in 95% of the patients in the GV group versus 85% in the DL group. The nasotracheal intubation performed with the direct laryngoscope (45.1±7.8 s) was significantly faster than that with the GlideScope (53.5±14.7 s), P less than 0.033. Magill forceps were used in 25% in the GV group, but were used 60% of the time in the DL group, P =0.02. The intubation failure rate was higher using the direct laryngoscope 15 versus 5% with the GlideScope, P =0.49. The incidence of a postoperative sore throat was significantly reduced in the GV group 15 versus 40% in the DL group, P =0.07. Conclusion Oral and maxillofacial surgery has a potentially difficult airway, but if managed properly, the morbidity and mortality can be reduced or avoided. The GVL can be used successfully for nasotracheal intubation in difficult airways in oral and maxillofacial surgery.