Use of the GlideScope for Airway Management in Patients with Craniofacial Anomalies

Abstract

Sir: An estimated 40 to 50 million anesthetics are administered each year in North America alone and as many again worldwide. In up to half of the cases, it is necessary to intubate the patient for airway management. This can be challenging and dangerous in the pediatric population, and even more so in the child with significant craniofacial anomalies. The standard laryngoscope blade, in conjunction with maneuvers performed by the laryngoscopist to improve their view, is not always adequate to visualize the epiglottis and/or vocal cords. In recent years, a number of airway devices have been introduced. Some of these devices offer a definite advantage when confronted with a difficult pediatric airway. The GlideScope videolaryngoscope (Saturn Biomedical Systems, Inc., British Columbia, Canada) is a relatively new device designed by a surgeon for management of the airway and, more specifically, the difficult airway (Fig. 1). It is essentially a lightweight laryngoscope that incorporates micro-video technology. The approximate weight of the handpiece is 0.12 kg. The 60-degree angle on the laryngoscope blade of the GlideScope enables visualization of the endotracheal tube in its trajectory toward the glottic opening. The laryngoscope blade includes an integrated camera with an antifogging mechanism and has been designed and developed to make the insertion of the endotracheal tube safe, reliable, and easy. The view from the camera in the handpiece is transferred to a small display monitor. The image of the airway structures provided is clear and sharp and is a significant improvement when compared with those obtained with direct laryngoscopy.Fig. 1.: Monitor, Glidescope videolaryngoscope handpiece, and carrying case.The Glidescope videolaryngoscope provides an unquestionable advantage in the airway management of children with craniofacial anomalies. Pediatric anesthesiologists can benefit from such a device, especially when they are presented with a challenging airway. In addition, clinicians who teach airway management skills will recognize that this device is an invaluable teaching tool, since both teacher and trainee are able to visualize the complex and variable airway anatomy. To date at our institution, the GlideScope videolaryngoscope has been used in numerous pediatric craniofacial cases and in even more routine pediatric cases, with excellent results. In our experience, anesthesia residents as well as other trainees to the device quickly acquire the skills necessary for visualizing the larynx and passage of the endotracheal tube with limited assistance from the attending anesthesiologist. While the time needed for intubation is certainly decreased, the possibility of trauma to the airway is also lessened. Concerns regarding this device might include a reliance on the technology to the point where clinicians lose the ability to perform direct laryngoscopy. Therefore, we recommend its use as a complement to, but not a replacement for, the traditional method of intubation. The laryngoscopist should remain proficient at intubating patients with the standard laryngoscope blade, but also be comfortable using this new technology. In addition, while the cost of the GlideScope videolaryngoscope is greater than that of the traditional laryngoscope, its use may save healthcare dollars when one considers the savings from possible patient morbidity or mortality related to the airway. Of note, the authors have no financial arrangement with the makers of the GlideScope videolaryngoscope. Peter J. Taub, M.D. Lester Silver, M.D. Division of Plastic and Reconstructive Surgery Cheryl K. Gooden, M.D. Department of Anesthesiology Mount Sinai Medical Center New York, N.Y.