: Breakage of the Disposable Blade during Laryngoscopy
Schirin M. Missaghi, MD,1 and Klaus Krasser, MD.1
1Staff Anesthetist and Intensive Care Physician, Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.
Address correspondence and comments to
Received from the Department of Anesthesia and
Intensive Care, Empress Elisabeth Hospital of the City of Vienna,
Vienna, Austria. Published:
January 28, 2008.
Received from the Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.
Published: January 28, 2008.
The correct citation of this correspondence for reference is:
Missaghi SM, Krasser K. Equipment malfunction of the GlideScope
Cobalt Video Laryngoscope: breakage of the disposable blade during
laryngoscopy. Internet Journal of Airway Management
Date accessed: month day, year.
Last updated: January 28, 2008.
The manufacturer of the various models and systems of the GlideScope Video Laryngoscope (GVL; Verathon Medical, Bothell, Washington, United States) recently released a new GVL model [the GlideScope Cobalt Video Laryngoscope (GCVL)] with a handle and a flexible camera unit for use with dedicated disposable laryngoscope blades (DLBs) together with the battery-powered, portable monitor of the Portable GlideScope Video System (2). The DLBs are available in two sizes for small and large adults, with a maximum thickness of 16.5 mm and lengths of 80 and 95 mm from the tip of the blades to the blade handles, respectively, and supplied in sterile packaging ready for use.
We are obliqued to communicate an observed equipment failure of the GCVL with breakage of the DLB during laryngoscopy in a patient with a previously experienced difficult airway (DA) due to limited mouth opening and restricted pharyngeal space, requiring flexible bronchoscopy-assisted tracheal intubation for laparoscopic cholecystectomy performed at our institution 7 years ago. This time, the patient was scheduled for thyroid surgery and included in a clinical investigation evaluating the GCVL for orotracheal intubation (1). After induction of general anesthesia and complete neuromuscular blockade, conventional laryngoscopy, provided by the study design, with a size 4 Macintosh laryngoscope blade revealed visualization of only the epiglottis. The GCVL with a large-sized DLB was introduced by an experienced GVL user midline into the oral cavitity and despite applying only gentle lifting force on the blade, the distal end of the DLB broke away from the body of the blade. Intermittent face-mask ventilation was abandoned in the fear of partial or complete airway obstruction. The broken DLB was immediately replaced with a new large-sized DBL and the broken part of the DLB was successfully removed under videolaryngoscopic view from the hypopharynx with the help of a Magill forceps and digital manipulation, although with difficulties.
The properly inserted GCVL provided then a laryngeal view of at least parts of the laryngeal aperture; using the Schroeder directional tracheal tube stylet (Parker Flex-It, Parker Medical, Englewood, Colorado, United States) for articulating and passage of the tracheal tube through the laryngeal aperture, tracheal intubation was successful within a short period of time without difficulties and problems, with oxygen saturations remaining in the normal range. The operative procedure and tracheal extubation was uneventful. Furtunately, the patient experienced no complaints associated with airway management evaluated at the postanesthesia care unit and during the visits on the few remaining postoperative days at the normal ward.
The Medical Product Agency of the Austrian Goverment Department of Health and the Austrian distributor as well as the manufacturer were immediately informed on this experienced equipment failure. The inventor of the GVL promptly responded and requested sending the broken DLB to the manufacturer for extensive examinations; of course, we complied this request. The manufacturer found no matieral fault and assured that such an incidence never occured since the release of the mechanically tested DLBs. Despite this experience, we are still enthusiasts for using GVLs as primary and backup devices for laryngoscopy and tracheal intubation in DA situations.
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