In reply

Abstract

We thank Dr. Russell for his insightful comments on our study. We hope that our results may add to the growing body of evidence that the GlideScope can be used in awake patients as an alternative to awake fiber optic tracheal intubation.1Doyle D.J. Awake intubation using the GlideScope video laryngoscope: initial experience in four cases.Can J Anaesth. 2004; 51: 520-521Crossref PubMed Scopus (65) Google Scholar, 2Jones P.M. Harle C.C. Avoiding awake intubation by performing awake GlideScope(R) laryngoscopy in the preoperative holding area.Can J Anaesth. 2006; 53: 1264-1265Crossref PubMed Scopus (14) Google Scholar, 3Xue F.S. Li C.W. Zhang G.H. et al.GlideScope-assisted awake fibreoptic intubation: initial experience in 13 patients.Anaesthesia. 2006; 61: 1014-1015Crossref PubMed Scopus (27) Google Scholar We chose to study the upright position for awake laryngoscopy because we were trying to address the specific clinical situation in which the supine position for laryngoscopy may cause the patient to clinically deteriorate. We agree that this position is likely to make passage of the endotracheal tube more difficult than the standard supine position and that further study needs to be conducted before this technique of upright “tomahawk” tracheal intubation is generally accepted as an alternative to awake, upright, fiber optic tracheal intubation. Nevertheless, other potential uses for awake upright Glidescope laryngoscopy, such as for visualization of the posterior pharynx, epiglottis, and glottis, as in cases of suspected foreign body or infection, might be judiciously undertaken in the meantime. GlideScope Versus Flexible Fiber Optic for Awake Upright LaryngoscopyAnnals of Emergency MedicineVol. 59Issue 3PreviewWe compare laryngoscopic quality and time to highest-grade view between a face-to-face approach with the GlideScope and traditional flexible fiber-optic laryngoscopy in awake, upright volunteers. Full-Text PDF GlideScope Versus Flexible Fiber Optic for Awake Upright LaryngoscopyAnnals of Emergency MedicineVol. 59Issue 3PreviewIn a randomized crossover study, Silverton et al1 compared the glottic view and time between GlideScope and flexible fiber optic laryngoscopy in awake volunteers in the upright position who received topical anesthetic. Laryngoscopy was faster with the GlideScope, and in the majority of individuals, at least a Cormack-Lehane grade 2 view was achieved, leading the authors to conclude that awake, face-to-face GlideScope use provided an alternative approach to the difficult airway. Full-Text PDF