Abstract

 

 

Objectives: We recently published our favorable experiences with the Lo Pro Adult GlideScope Video Laryngoscope (LGVL) and were interested to evaluate the performance of the new GlideScope Ranger Video Laryngoscope (GRVL) with a significantly modified blade design and a minituarized portable monitor 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: One hundred and eight adult patients undergoing elective thyroid surgery were investigated.

 

Operators: The operators (8 staff anesthetists, 2 anesthesia residents, and one qualified anesthesia nurse) were experienced users of the LGVL. For this study, they performed GRVL-assisted laryngoscopy and tracheal intubation attempts on from 6 to 12 (median: 8) 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 GRVL were evaluated using the same technique as for CL and the 5-grade scoring system. When laryngeal structures were visible, GRVL-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 38, 28, 22, 18, and 2 patients, respectively. In all patients, GRVL-assisted tracheal intubation was successful at the first attempt with laryngeal views of grade 1 and 2 in 102 and 6 patients, respectively. Minor problems and difficulties with impeded TT advancement during oropharyngeal, laryngeal, and/o tracheal passage were encountered in altogether 20 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.

 

Conclusions: Performed by experienced LGVL users, the success of GRVL-assisted tracheal intubation as with the LGVL was not affected by CLV. The GRLV proved to be uniquely useful for routine and difficult laryngoscopy and tracheal intubation.  

 

 

Introduction