Doyle DJ. Awake intubation using the GlideScope video laryngoscope: initial experience in four cases. Can J Anaesth. 2004 51:520-1.

Awake Intubation Using the Glidescope® Video Laryngoscope: Initial Experience in Four Cases

D. John Doyle, MD PhD FRCPC
Department of General Anesthesiology
Cleveland Clinic Foundation 

The GlideScope® Video Laryngoscope (GVL) (Saturn Biomedical Systems, Burnaby, BC, Canada) is a novel system for tracheal intubation that utilizes a video camera embedded into a plastic laryngoscope blade [1,2]. The blade is 18 mm at its maximum width, and bends 60 degrees at the mid-line. This configuration provides a view superior to that obtained with a conventional laryngoscope (Figure 1). Experience using the GVL in anesthetized patients has been excellent, but limited [1, 2]; experience in awake patients is even more limited. The purpose of this note is to describe use of the GVL in four cases of awake intubation.

In the first two cases the initial plan was to use fiberoptic methods, but the equipment was unavailable, so the GVL was used instead. Later, having had a prior favorable experience, the GVL was used electively, even though a difficult airway cart was available. In three cases the indication for awake intubation was morbid obesity. The remaining patient had a limited mouth opening (2.5 cm) that would have made ordinary intubation difficult.

Following sedation with midazolam, the airway was anesthetized with gargled and atomized 4% lidocaine; superior laryngeal and transtracheal blocks were not employed. Once a good view of the glottis was obtained, additional lidocaine was administered under direct vision, using a MADgic® atomizer (Wolfe Tory Medical, Salt Lake City, USA).  A malleable stylet bent at 90 degrees was used. In all cases a good view of the glottis was obtained and the endotracheal tube (ETT) was passed without difficulty. In the patient with limited mouth opening the GVL was just able to be introduced.

There are several advantages of using the GVL for awake intubation. First, the view is excellent. Second, the method is less affected by secretions or blood as compared to fiberoptic intubation. Third, everyone can view the intubation, while this is the case only for video bronchoscopes. Fourth, the intubation can be recorded using a regular camcorder. Fifth, there are no restrictions on the type of ETT that can be placed, while this is not the case for fiberoptic methods. Sixth, the GVL is more rugged than a bronchoscope, and is less susceptible to damage. Seventh, the GVL is easily cleaned. Finally, while advancing the ETT into the trachea over a bronchoscope often fails as a result of the ETT impinging on the arytenoid cartilages [3], this is not a problem with the GVL.

References

[1] Cooper R. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611-613

[2] Agro F. Barzoi G. Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. British Journal of Anaesthesia. 2003;  90:705-6.

[3] Katsnelson T, Frost EAM, Farcon E, Goldinger PL. When the endotracheal tube will not pass over the flexible fiberoptic bronchoscope. Anesthesiology 1992; 76: 151–2.

Figure 1. Close-up views of the glottis showing an endotracheal tube passing through the vocal cords.