Use Of GlideScope Research Articles

Cardiovascular responses to laryngoscopy and tracheal intubation with GlideScope or Macintosh laryngoscope in elderly patients undergoing gynecologic surgery: A randomize clinical trial

Introduction: The purpose of this study was to compare the GlideScope and Macintosh laryngoscopes for cardiovascular response to laryngoscopy and endotracheal intubation in elderly patients undergoing gynecological procedures. Methods: In this clinical trial, endotracheal intubation was performed using a GlideScope (study group; n=35) and Macintosh laryngoscope (control group; n=35). Hemodynamic parameters were recorded, before induction of anesthesia (baseline), 30 and 15 seconds after starting the laryngoscopy, and every minute up to 5 minutes after intubation. Intubation time and complications of laryngoscopy and intubation were compared between two study groups. Results: Systolic blood pressure (SBP) in 1 (P=0.002), 2 (P=0.003) and 3 (P=0.003) minutes were significantly lower in the study group than that of the control group. The duration of laryngoscopy and intubation was not statistically different between two study groups. The frequency of hypertension after endotracheal intubation in the study group (20%) was significantly lower than that of patients in the control group (45.7%) (P=0.02). There was no significant difference in terms of postoperative complications related to laryngoscopy and intubation (hoarseness and sore throat) between two study groups (P>0.05). Conclusion: This study showed that the use of GlideScope better attenuated cardiovascular responses to laryngoscopy and intubation compared to Macintosh laryngoscope in elderly patients undergoing gynecologic surgery. Also, the frequency of hypertension following laryngoscopy and endotracheal intubation was lower with GlideScope compared to Macintosh laryngoscope. Durations of laryngoscopy, intubation and postoperative complications related to airway management (hoarseness and sore throat) were similar.

The Incidence of Trauma with the Use of Glidescope in Anticipated Difficult Airway Cases – A Prospective Observational Study

Background: Glidescope video-laryngoscope (GVL) is an invaluable equipment for patients with anticipated difficult intubations that aids in visualizing the vocal cords out of line-of-sight. However, despite the ease in the visualization and shortening of the time taken to visualise the cords, the intubation time is often prolonged and is associated with trauma. This study aims at identifying incidence of trauma with glidescope in anticipated difficult airway scenario and whether correct practice by experienced anesthesiologist can reduce trauma. Methodology: Eighty-nine adult patients with anticipated difficult airway who were intubated using GVL by experienced anesthesiologists in a tertiary care setting were studied. The time to visualize, the time to intubate, the difficulties encountered at intubation were documented, the incidence of trauma was reported. The factors associated with trauma were analyzed using PSPP software (psppire. exe 0.8.4-g012d99). Results: The incidence of airway trauma was 11.2%. It was higher in the group with technical difficulties (Gtd) (P < 0.001) and was less in the hands of an experienced anesthesiologist (P = 0.02). Conclusion: GVL intubation in anticipated difficult airway cases by experienced anesthesiologists using the right technique has lesser incidence of trauma, lesser than that is seen with Macintosh intubations in anticipated difficult airway scenario. Knowledge on techniques to troubleshoot technical difficulties with GVL may reduce the incidence of trauma further and needs to be studied more.

Use of GlideScope in Patients Undergoing NIM Thyroidectomy.

Thyroidectomy and parathyroidectomy using the nerve integrity monitor (NIM) require proper placement of the endotracheal tube with electrodes aligned correctly within the larynx. The purpose of this study is to determine the percentage of patients who require positional adjustments of the endotracheal tube prior to beginning surgery and to understand the value of using the GlideScope to assure proper NIM tube placement within the larynx. This prospective study examines operative data from 297 patients who underwent NIM thyroidectomy and parathyroidectomy. After routine orotracheal intubation by an anesthesiologist and positioning of the patient for surgery, a GlideScope was used to check the position of the tube in 2 planes: depth of tube placement and rotation of the tube within the larynx assuring proper placement of the electromyogram electrodes within the glottis. Tube adjustment was required for 66.5% of patients. In 48.1% of cases, tube retraction or advancement to a proper depth was needed. Tube rotation was required for 30.1% of patients, and 11.8% of patients required both adjustment of tube depth and tube rotation to properly align electrodes. After the anesthesiologist places the NIM endotracheal tube, and the patient is positioned for surgery, additional tube adjustment is often needed prior to the start of surgery. The GlideScope is readily available in the operating suite, its use adds little time to the procedure, and assures proper NIM tube placement. The use of the GlideScope is recommended.

Difficult airway management practice changes after introduction of the GlideScope videolaryngoscope: A retrospective cohort study.

Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management. The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques. Retrospective cohort study. Tertiary care referral centre. Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems. Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P < 0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [before 149/8306 (1.8%); after 85/8517 (1.0%), P < 0.0001]. The GlideScope replaced flexible fibreoptic bronchoscopy in most cases with expected and unexpected difficult intubation. In patients with limited mouth opening, flexible fibreoptic bronchoscopy was still mostly the first choice after the introduction of the GlideScope. There was a 70% reduction in the use of other difficult intubation techniques after the introduction of the GlideScope [before 84/8306 (1.0%); after 22/8517 (0.3%), P < 0.0001)]. The GlideScope videolaryngoscope replaced flexible fibreoptic bronchoscopy for most patients with expected and unexpected difficult intubation. In the case of limited mouth opening, flexible fibreoptic bronchoscopy was still the first choice after the introduction of the GlideScope. The reduced use of flexible fibreoptic bronchoscopy raises concerns that residents may not be adequately trained in this essential airway management technique. GlideScope use was disproportionately greater than the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.

Use of Glide-scope in Trial Extubation of the Difficult Airway: Letter to the Editor

Use of Glide-scope in Trial Extubation of the Difficult Airway: Letter to the Editor

Video Laryngoscopy vs. Direct Laryngoscopy.

Video Laryngoscopy vs. Direct Laryngoscopy.

A prospective randomized controlled study to evaluate and compare GlideScope with Macintosh laryngoscope for ease of endotracheal intubation in adult patients undergoing elective surgery under general anesthesia

Background:The aim of the study was to compare the ease the intubation using GlideScope video laryngoscope and Macintosh laryngoscope in adult patients undergoing elective surgery under general anesthesia.Materials and Methods:A total of 200 American Society of Anesthesiologists I–II patients of either sex, in the age group of 18–60 years were included in the study. Patients were randomly allocated to two groups. We assessed ease of intubation depending on time to tracheal intubation, number of attempts, glottic view (Cormack–Lehane grade [CL grade] and percentage of glottis opening [POGO]) and intubation difficulty score (IDS), hemodynamic variables and any intra- and post-operative adverse events.Results:The rate of successful endotracheal intubation (ETI) in both groups was 100% in the first attempt. The time required for successful ETI was 24.89 ± 5.574 in Group G and 20.68 ± 3.637 in Group M (P < 0.001) found to be statistically significant. There was significant improvement in glottic view with GlideScope (as assessed by POGO score 66.71 ± 29.929 and 94.40 ± 10.476 in group G and 75.85 ± 26.969 and 74.20 ± 29.514 Group M and CL grading [P < 0.001]). A comparison of mean IDS between two groups revealed intubation was easier with the use of GlideScope. The hemodynamic response to intubation was significantly lesser with the use of GlideScope when compared with Macintosh laryngoscope. The incidence of adverse events, though minor like superficial lip or tongue bleed, was similar in two groups.Conclusions:GlideScope offers superiority over Macintosh laryngoscope in terms of laryngeal views and the difficulty encountered at ETI in an unselected population.

The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry

BackgroundWe analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope® videolaryngoscopy. MethodsData collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed. ResultsInitial (464/877 = 53% vs 33/828 = 4%, Z-test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5–2.5, P < 0.001). ConclusionsDuring difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.

Incidence and severity of postoperative sore throat: a randomized comparison of Glidescope with Macintosh laryngoscope

BackgroundPostoperative sore throat (POST) is a common problem following endotracheal (ET) intubation during general anesthesia. The objective was to compare the incidence and severity of POST during routine intubation with Glidescope (GL) and Macintosh laryngoscope (MCL).MethodsOne hundred forty adult patients ASA I and II with normal airway, scheduled to undergo elective surgery under GA requiring ET intubation were enrolled in this prospective randomized study and were randomly divided in two groups, GL and MCL. Incidence and severity of POST was evaluated at 0, 6, 12 and 24 h after surgery.ResultsAt 0 h, the incidence of POST was more in MCL than GL (n = 41 v.s n = 22, P = 0.001), and also at 6 h after surgery (n = 37 v.s n = 23, P = 0.017). Severity of POST was more at 0, 6 and 12 h after surgery in MCL (P < 0.001, P = 0.001, P = 0.004 respectively).ConclusionsRoutine use of GL for ET tube placement results in reduction in the incidence and severity of POST compared to MCL.Trial regisrationClinicalTrials.gov NCT02848365. Retrospectively Registered (Date of registration: July, 2016).

Management of Complex Airway Caused by Massive Retropharyngeal Goiter

Abstract Introduction: The patient is a 52-year-old male with massive retropharyngeal thyroid goiter causing compressive symptoms and a complex airway. This intraoperative video demonstrates simultaneous Glidescope exposure with flexible fiberoptic laryngoscopy utilizing the Seldinger technique to intubate. Materials and Methods: This is a single patient case presentation using pre and postoperative flexible fiberoptic nasopharyngoscopy and intraoperative Glidescope video. Results: Management of the complex airway with resolution of compressive symptoms after total thyroidectomy was effective. Conclusions: Simultaneous use of Glidescope for exposure with flexible fiberoptic laryngoscopy utilizing the Seldinger technique is a viable option for managing complex airways caused by massive retropharyngeal goiters. D.J.T. has been a speaker for Genzyme during the past 2 years. All other authors have no other potential conflicts to disclose. This case is to be presented on a panel at the World Congress on Thyroi...

Use of Glidescope in Trial Extubation of the Difficult Airway

Use of Glidescope in Trial Extubation of the Difficult Airway

When everything failed, glidescope prevailed.

Sir, We report the successful management of an unanticipated difficult airway secondary to an asymptomatic large vallecular cyst obscuring the glottic opening using glidescope after repeated failed attempts at mask ventilation and laryngoscopy. A 70-year-old, 60 kg, American Society of Anesthesiologists (ASA) I male patient was scheduled to undergo re-exploration for persistent bleeding following transurethral resection of the prostate. The preanesthetic checkup and airway examination was unremarkable. General Anesthesia was planned in view of ongoing blood loss. Patient was shifted to the operating room and connected to the multichannel monitor (Datex-Ohmeda, Finland). Intravenous access (i.v.) was established with 18G cannula, and i.v. glycopyrrolate 0.2 mg and morphine 6 mg was given. Patient was preoxygenated with 100% oxygen for 3 min and then induced with sleep dose of thiopentone. After confirming assisted mask ventilation, i.v vecuronium (0.1 mg/kg) was given but, immediately after full muscle relaxation was achieved, absent capnography trace along with minimal movement of the chest was noticed. Guedel's airway was inserted, mask position and adequate seal reconfirmed and any leaks or equipment failure was ruled out. With failure to ventilate even now, it was decided to perform direct laryngoscopy to facilitate endotracheal intubation. Meanwhile, the anesthesia technician was also requested to bring a glidescope as the fiberoptic bronchoscope was not available. Since the patient was routinely preoxygenated with 100% oxygen, the SpO2 could be maintained at around 93% throughout till successful intubation could be accomplished. A large vallecular cyst was detected arising from the right vallecula obscuring the glottic opening entirely [Figure 1]. After two unsuccessful attempts to visualize the glottis, it was decided to use glidescope which revealed a small aperture glottic opening, distorted and displaced by the cyst. 7.0 mm cuffed oral endotracheal tube was passed beyond the cyst into the trachea and confirmed by capnogram. The cyst was then aspirated to prevent any problems at extubation. Patient was maintained on controlled ventilation using 66% nitrous oxide in oxygen with 1% isoflurane. He also received i.v 8 mg of dexamethasone following intubation. The surgery continued uneventfully for 1 h. At the end of surgery, neuromuscular blockade was reversed with 50 μg/kg of i.v neostigmine and 10 μg/kg of i.v glycopyrrolate. His trachea was extubated uneventfully. He was then shifted to postanesthesia care unit and discharged from the ward 2 days later.Figure 1: Vallecular cyst obstructing the laryngeal inletGlidescope is a new addition to the armamentarium for managing a difficult airway. Although it has been used to achieve primary airway control in anticipated, symptomatic large vallecular cyst,[1] it also helps in unanticipated difficult airway by improving the Cormack-Lehane grading and making part of the airway visible. By virtue of its inherent design of bent tip at 60°, the structures that are obscured on direct laryngoscope may be readily observed with the use of glidescope.[23] It is already established that the use of glidescope has a high success rate in both primary airway control as well as failed direct laryngoscopy.[4] The ASA difficult airway guidelines have also incorporated glidescope for improved laryngeal view and increased successful intubations.[5] This equipment use avoids multiple attempts at successful tracheal intubation. Therefore, it may be used as a tangible alternative device in a situation where tracheal placement seems to be rather difficult or impossible.

Use of the GlideScope®for double-lumen endobronchial intubation

Dr Russell et al. recently published the results of a randomised controlled trial comparing the GlideScope® with the Macintosh laryngoscope for double-lumen endobronchial intubation 1. We would like to thank our colleagues from Toronto for performing this study, which provides useful information on the use of GlideScope for this purpose, but wish to comment on some aspects of this study compared with a preliminary observational study published in 2012 2. Firstly, the operators were similar in both centres with regard to training with the GlideScope and also with the concomitant use of the GlideScope with double-lumen endobronchial intubation. The ratio of operators to cases was comparable, with 30 operators/80 cases (38%) in Toronto and 17/50 (34%) at our institution. Secondly, the authors reported a 17% failure for first attempt at intubation with the GlideScope, compared with 9% with the Macintosh, stating that these results are similar to those in our study. We indeed reported a failure rate of 26% on the first attempt with the GlideScope in our study, but the time allowed to succeed was 60 s, as opposed to 120 s in Toronto. In Quebec City, our failure rate was 4% at 120 s (unpublished data). Thirdly, Russell et al. reported that three out of 40 cases had cuff rupture with the GlideScope, but none in the Macintosh group. Unfortunately, they did not mention how many subjects had upper teeth. In our study, we had 17/50 (34%) subjects with upper teeth and we had no tracheal cuff ruptures. This occurs frequently in the presence of upper teeth when using a double-lumen endobronchial tube. We described in 1999 a technique to help minimise this problem, simply by inserting the tube in the mouth before the laryngoscope, and we use it successfully with the GlideScope as well 3. Fourthly, the main difference between these two studies is that we used the GlideRite Double-Lumen Tube Stylet (GR-DLT-S) we designed in 2009, in collaboration with Verathon Medical Inc. (Bothell, Washington, USA). This semi-rigid stylet is a safe and effective way to ease the insertion of the double-lumen endobronchial tube with minimal trauma. In Toronto, the original malleable stylet supplied with the double-lumen endobronchial tube was used. The operator shaped it to replicate the curve of the GlideScope or the Macintosh blade's curvature as needed. In our experience, this original aluminium stylet is too malleable and does not maintain its curvature when facing any obstruction in the upper airway. We postulate that the difference in the rate of success at 120 s (96% in our study vs 83% in the Toronto study) might be explained by the use of different stylets, knowing that operators had similar expertise with the GlideScope. We agree with the authors that the GlideScope is not an easy device to use for double-lumen endobronchial intubation, particularly with novices. Our conclusion is that using GlideScope in combination with a double-lumen endobronchial tube requires training. The presence of upper teeth and small mouth opening might add some degree of difficulty but the use of special techniques and facilitating tools, such as the GR-DLT-S, can greatly improve the success rate of intubation. In our teaching institution, we encourage the use of the GlideScope/DLT/GR-DLT-S combination for every case in order to develop our expertise with these devices and to enable us to be more efficient when facing a difficult intubation.

The usefulness of Glidescope in the placement of double lumen tubes

The usefulness of Glidescope in the placement of double lumen tubes

The use of GlideScope for biopsies of the tongue base

To report a case where GlideScope is used for the biopsy of the tongue base. GlideScopes are used by anaesthetists for difficult intubations. This paper reports a case where a GlideScope was used for biopsy of the tongue base. A review of the literature indicated that this was the first time a GlideScope had been utilised for this purpose. It is suggested that this is a safe and ideal technique for biopsy of the tongue base, and GlideScopes could be used more frequently for this purpose in the future.

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Introduction: Rapid sequence intubation (RSI) is one of the most frequently performed procedures in emergency departments, but data describing the optimal sedative agent for induction during this procedure are limited. Hypothesis: The objective of this study was to compare the effectiveness of etomidate versus ketamine for RSI as measured by first-attempt intubation success. We hypothesized that ketamine is as effective as etomidate with regard to intubation success. Methods: This was a retrospective cohort study of prospectively collected data recorded in a quality improvement database between July 1st, 2007 and March 1st, 2012. The database contained information on all consecutive intubations performed in the emergency department during this time period. A multivariate logistic regression analysis was performed to determine the effect of sedative type on first-attempt intubation success. The model included other potential confounders such age, sex, trauma status, paralytic, difficult airway parameters, physician specialty, physician experience, reason for intubation and device used. Results: A total of 1511 RSIs were included in the final analyses. Of these, 1434 received etomidate and 77 received ketamine. The unadjusted rate of first-attempt intubation success was similar between the etomidate and ketamine groups (75% versus 83%, respectively; p=0.105;). In the multivariate analysis, variables predictive of first-attempt intubation success were sex (OR 0.70, 95% CI 0.99-1.00, p = 0.01), trauma status (OR 0.73, 95% CI 0.54-0.98, p = 0.04), intubation for cardiac arrest (OR 0.28, 95% CI 0.14-0.58, p<0.001), presence of at least one difficult airway parameter (OR 0.45, 95% CI 0.33-0.61, p<0.001), and use of GlideScope or C-Mac video laryngoscopes (OR 2.16, 95% CI 1.60-2.92, p < 0.001 and OR 2.23, 95% CI 1.51 to 3.28, respectively; p<0.001). After adjusting for potential confounders sedative type was not predictive of first-attempt intubation success (OR 0.72, 95% CI 0.38-1.36, p=0.305). Conclusions: Etomidate and ketamine produce equivalent rates of first-attempt intubation success in the emergency department.

Use of Glidescope® as a first-choice technique in Klippel-Feil syndrome airway management

Marques, J.; Henriques, A. R.; Bettencourt, M.; Figueiredo, J. N.; Chaló, D. Author Information

Use of GlideScope in airway management of a patient with osteogenesis imperfecta

To the Editor: Patients with osteogenesis imperfecta (OI) have multiple factors that impact airway management, including megalocephaly, macroglossia, and a short neck, which may be complicated by the potential risk of cervical spine injury during neck extension. We present the first reported case of the use of the GlideScope for endotracheal intubation in a patient with severe OI. A 65-year-old woman (86 cm tall, 18.6 kg) with OI congenita was admitted for umbilical hernia repair. She had a history of multiple extremity fractures and contractures, fractures with coughing, and scoliosis (Fig. 1). Airway examination showed mild macroglossia, Mallampati grade II, 3-cm mouth opening, and neck fixed in 20 extension. Planned anesthetic management included local anesthesia and sedation with midazolam 2 mg and fentanyl 125 lg IV. The incision site was infiltrated with local anesthetic. The patient tolerated the procedure until intraperitoneal stimulation caused herniation of abdominal contents, so general anesthesia was induced with propofol 2 mg/kg and rocuronium 1 mg/kg IV. A mask airway was easily obtained. Succinylcholine was avoided because of the risk of fasciculation-induced fractures. Placement of a #3 laryngeal mask airway (LMA) was attempted, but the distorted oral anatomy would not allow it to advance into the hypopharynx. The patient was easily intubated using a GlideScope #3 and cuffed endotracheal tube size 5.5 with in-line stabilization. Direct laryngoscopy was avoided to prevent facial, dental, or spinal trauma. Anesthesia was maintained with O2 and propofol, avoiding volatile triggers for malignant hyperthermia [1]. Blood pressure was measured with a pediatric cuff, set at child inflation limits, every 15 min. The patient was extubated after reversal of muscle relaxation with no coughing. Postoperatively, the patient had a mild sore throat, but no injuries or nausea. She was discharged home on postoperative day 3. Osteogenesis imperfecta is an autosomal dominant disorder characterized by defective synthesis of collagen type I (abnormal mineralization) and a triad of skeletal fragility, blue sclera, and conductive hearing loss [2]. Preoperative evaluation should include an echocardiogram, pulmonary function tests, and assessment of platelet function. Airway management can be complicated by macroglossia, cervical spine problems, micrognathia, and dental fractures with minimal manipulation. The GlideScope uses less force as compared to conventional laryngoscopy. It has an antifogging mechanism and unique angulation permitting a better view of the anterior glottis and can be used with inline stabilization. The distortion of anterior airway anatomy is reduced with use of GlideScope as compared to a Macintosh blade. Cervical extension between the occiput and C4 as well as anterior deviations of the vertebral bodies from baseline are significantly less with the GlideScope [3]. Previous reports illustrate the use of nasal fiberoptic intubation in patients with OI and dental anomalies presenting for maxillary surgery. LMA and intubating LMA F. A. Khan (&) S. Shah S. Shah V. Mandoff W. Brooks Gentry Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 515, Little Rock, AR 72205, USA e-mail: fakhan@uams.edu

GlideScope Versus Flexible Fiber Optic for Awake Upright Laryngoscopy

We 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. This was a prospective, randomized, crossover study in which we performed awake laryngoscopy under local anesthesia on 23 healthy volunteers, using both a GlideScope video laryngoscopy face-to-face technique with the blade held upside down and flexible fiber-optic laryngoscopy. Operator reports of Cormack-Lehane laryngoscopic views and video-reviewed time to highest-grade view, as well as number of attempts, were recorded. Ten women and 13 men participated. A grade II or better view was obtained with GlideScope video laryngoscopy in 22 of 23 (95.6%) participants and in 23 of 23 (100%) participants with flexible fiber-optic laryngoscopy (relative risk GlideScope video laryngoscopy versus flexible fiber-optic laryngoscopy 0.96; 95% confidence interval 0.88 to 1.04). Median time to highest-grade view for GlideScope video laryngoscopy was 16 seconds (interquartile range 9 to 34) versus 51 seconds (interquartile range 35 to 96) for flexible fiber-optic laryngoscopy. A distribution of interindividual differences demonstrated that GlideScope video laryngoscopy was, on average, 39 seconds faster than flexible fiber-optic laryngoscopy (95% confidence interval 0.2 to 76.9 seconds). GlideScope video laryngoscopy can be used to obtain a Cormack-Lehane grade II or better view in the majority of awake, healthy volunteers when an upright face-to-face approach is used and was slightly faster than traditional flexible fiber-optic laryngoscopy. However, flexible fiber-optic laryngoscopy may be more reliable at obtaining high-grade views of the larynx. Awake, face-to-face GlideScope use may offer an alternative approach to the difficulty airway, particularly among providers uncomfortable with flexible fiber-optic laryngoscopy.

Use of GlideScope for NIM EMG Endotracheal Intubation during Recurrent Laryngeal Nerve Monitoring

Objective: The proper positioning of the NIM EMG endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. In this article we describe our experience with the GlideScope and how it facilitates the accurate placement of the NIM EMG endotracheal tube. Method: NIM EMG endotracheal intubation was performed in 50 consecutive thyroidectomies using the GlideScope video laryngoscope (Verathon Medical, Bothell, Washington). The correct positioning of the tube was determined by impedance values of less than 5 kX and impedance imbalance of less than 1 kX. Results: Successful intubation was achieved in all the cases using the GlideScope. The GlideScope helped in the correct placement of the NIM endotracheal tube in the majority of the cases. Conclusion: Use of the GlideScope is an excellent method to ensure the correct positioning of the NIM tube allowing both the surgeon and the anesthesiologist to participate in the intubation process and confirm correct placement of the tube while also allowing a gentle intubation with improved visibility.