Intoduction to the Glidescope Video Laryngoscope: Experience to Date in Over 1000 Cases
A Light Emitting Diode (LED) solid state light source assembly mounted beside the camera provides illumination. The resulting monochrome video image is displayed on a supplied 7" Liquid Crystal Display (LCD) monitor, but can also be displayed externally or recorded electronically. The unit is commercially available and FDA approved. It is easily cleaned using cold sterilization solution.
In this brief report we present some preliminary observations concerning the use of the GVL in a series of over 1000 cases since March 2003. The main purpose of using the GVL for these cases was to obtain clinical familiarity with the system and to compare it informally to other airway management technologies. Another objective was to introduce residents and colleagues to the system and get their clinical impressions. Based on this experience the following observations were made.
Because the laryngoscope is made of plastic, it looks inexpensive and may be mistakenly thought to be disposable. In fact, despite appearances, the unit is very rugged and should withstand considerable wear and tear. The laryngoscope is generally very easy to introduce into the oropharynx. The maximum width of the blade is 18 mm, an amount needed to accommodate the microminiature TV camera. While it is likely that in some patients with very limited mouth opening the 18 mm maximum width of the blade could present a problem, this was not our experience in all but a few patients.
The use of the GVL requires almost no prior training. In most cases where residents or colleagues were introduced to the system, we merely instructed them to use the device like a regular Macintosh laryngoscope with the exception that they were told to intubate with the head in the neutral position and that they should watch the LCD display monitor instead of looking directly. In almost all cases, no difficulties were encountered in obtaining an adequate view in the few seconds it took most users to learn to manipulate the laryngoscope. In some cases the view was improved with posterior displacement of the trachea, but in other cases this maneuver was not helpful. The fact that the view in early models is monochrome (black and white) and not in color was not perceived to be a significant drawback; however the new models all offer color images. Finally, the fact that several individuals can simultaneously witness the intubation on the LCD display is of enormous teaching value.
We found that the principal limitation in using the system was not in getting a good view of the glottis, but rather in manipulating the endotracheal tube (ETT) through the vocal cords. It was immediately apparent with the first use of the unit that using an ordinary ETT without a stylette would result in a floppy ETT that would be very hard to direct through the cords, and that successful placement almost always required some form of stylette, such as a Mallinckrodt Satin-Slip® Intubating Stylet, in order to avoid the ETT from ending up in an excessively posterior position.
In an attempt to find a means by which the ETT might be directed more anteriorly in cases where the ETT ended up posteriorally despite use of a stylet, we tried using a Parker Flex-It Stylet instead of the Mallinckrodt Satin-Slip® Intubating Stylet. This device allows its curvature to be remotely adjusted during intubation with a thumb control. This appeared to be moderately helpful in solving this problem. With further experience, it became clear that the best way to avoid this problem was to ensure that the laryngoscope is not introduced into the oropharynx any more than is necessary to get a good view of the glottis.
In conclusion, the GlideScope® Video Laryngoscope is a new approach to tracheal intubation that is easy to master and appears to have considerable clinical potential.
D. John Doyle MD PhD FRCPC
Department of General Anesthesiology
Cleveland Clinic Foundation
9500 Euclid Avenue E31
Cleveland, Ohio, 44195
doylej@ccf.org
April 26, 2006
