Abstract

 

 

Objectives: We recently published our favorable experiences with the former Standard Adult GlideScope Video Laryngoscope (SGVL) and were interested to evaluate the performance of the new lower-profile version, the Lo Pro Adult GlideScope Video Laryngoscope (LGVL), in patients requiring orotracheal intubation.

 

Design: Patients with previously experienced difficult conventional tracheal intubation, anatomic features predictive for difficult conventional laryngoscopy (CL) and tracheal intubation, and/or obesity were given preferential enrollment into the study. Therefore, this clinical investigation represents data of a prospective, but non-consecutive observational study.

 

Setting: The study was performed at a community hospital with a reference center for the management of thyroid diseases.

 

Patients: Four hundred and forty-two patients undergoing elective thyroid surgery were investigated.

 

Operators: The operators (10 staff anesthetists, 4 anesthesia residents, and one qualified anesthesia nurse) were experienced users of the SGVL. For this study, they performed LGVL-assisted laryngoscopy and tracheal intubation attempts on from 16 to 42 (median: 24) patients.

 

Interventions: Conventional laryngoscopic view grading (CLV) was performed with a standard  Macintosh laryngoscope using gentle lifting force without external laryngeal manipulation: grade 1, visualization of the entire laryngeal aperture; grade 2, visualization of just the posterior portion of the laryngeal aperture; grade 3, visualization of only the arytenoids; grade 4, visualization of only the epiglottis; and grade 5, visualization of just the soft palate. The laryngeal views obtained with the LGVL were evaluated using the same technique as for CL and the 5-grade scoring system. When laryngeal structures were visible, LGVL-assisted tracheal intubation was attempted using the Schroeder directional tracheal tube stylet (DS) for manipulation of the tracheal tube (TT) through the laryngeal aperture.  

 

Measurements and Main Results:  Laryngeal views of grade 1 to 5 at CL were obtained in 137, 103, 97, 96, and 9 patients, respectively. The success rate of LGLV-assisted tracheal intubation at the first attempt was 98.0 percent (437/442 patients) with laryngeal views of grade 1, 2, and 3 in 351, 80, and 6 patients, respectively; the causes of primary failures of tracheal intubation were failed TT advancement during laryngeal passage in 4 patients and tracheal passage in one patient. Minor problems and difficulties with impeded TT advancement during oropharyngeal, laryngeal, and/or tracheal passage were encountered in altogether 16 percent; there were no problems with impeded blade insertion due to limited mouth opening and/or restricted pharyngeal space and poor visibilty due to the presence of secretions and/or fogging of the camera system. The remaining 5 patients required a second attempt for successful tracheal intubation.

 

Conclusions: Performed by experienced users of the SGVL, success of GVL-asisted tracheal intubation with the LGVL was not affected by CLV as observed in the study with the SGVL. The LGVL together with the DS proved to be uniquely useful for routine and difficult laryngoscopy and tracheal intubation.  

 

 

Introduction