Measures to facilitate smooth insertion of an endotracheal tube into the trachea with GlideScope videolaryngoscopy

Xue, Fu Shan; Liu, He P.; Liao, Xu; Zhang, Yan M.

doi:10.1016/j.jclinane.2008.12.014

Cited by 6 publications

(6 citation statements)

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“…Difficulty in tube insertion: When the tracheal intubation is performed with videolaryngoscopy, the ability to exposure the larynx does not correlate with successful intubation; namely, a good videolaryngoscopic view of the glottis does not guarantee easy and successful intubation (63). This is especially true for videolaryngoscopes with sharply angulated and channelled blades (60).…”

Section: How To Get the Best Out Of Videolaryngoscopymentioning

confidence: 99%

“…In this way, the operator needs to pre-shape the tracheal tube with a rigid stylet, to an angle to match the blade's curvature (63). This great tube bend angle can create tube passage problems with the videolaryngoscopy as the tracheal tube tends to be directed into the larynx with an angle almost perpendicular to the axis of the trachea (10).…”

Section: How To Get the Best Out Of Videolaryngoscopymentioning

confidence: 99%

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Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Xue¹,

Liu²,

Li³

et al. 2016

J Anesth Perioper Med

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Aim of review:The aim of this article is to review the recent literatures regarding videolaryngoscopes, compare performance of videolaryngoscopy versus direct laryngoscopy, discuss the role of videolaryngoscopy in clinical airway management and provide the measures that can improve the performance of videolaryngoscopy and decrease complications associated with videolaryngoscopy. Methods: The literatures about the use of videolaryngoscopes in the clinical airway management, published in the past decades, were searched from the Pubmed and Cochrane databases and reviewed, in order to determine their performance, and identify their limitations and find appropriate alternate techniques to overcome their shortcomings and failures. Recent findings: Videolaryngoscopes are promising intubation devices, which are easy to use, and the skills involved are easy to obtain by either novices or experienced intubators. In the current practice, videolaryngoscopes are commonly used as main devices of predicted difficult airways and as rescue tools of difficult or failed direct laryngoscopy. For patients with difficult airways, videolaryngoscopy can provide an improved laryngeal visualization and achieve a higher intubation success rate compared with direct laryngoscopy. Moreover, videolaryngoscopy has the potential to increase patient safety by facilitating learning, teaching, and success of tracheal intubation. Despite the very good laryngeal visualization, the insertion and advancement of the tracheal tube with videolaryngoscopy may occasionally fail, and the airway injuries associated with videolaryngoscopy can occur. Summary: The introduction of videolaryngoscopy has resulted in a dramatic transformation of clinical airway management and is seen as the evolutionary step in intubation technology. There are several different types of videolaryngoscopes available. Each device's features may offer advantages or disadvantages, depending on the situation the anesthetist has to deal with. To get the best out of videolaryngoscopy, all anesthetists must be trained in the use of videolaryngoscopes and such devices should be available in all sites where tracheal intubation is performed.

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Section: How To Get the Best Out Of Videolaryngoscopymentioning

confidence: 99%

Section: How To Get the Best Out Of Videolaryngoscopymentioning

confidence: 99%

Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Xue¹,

Liu²,

Li³

et al. 2016

J Anesth Perioper Med

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“…When tracheal intubation is performed using the GlideScope ® , the ability to view the larynx does not correlate with successful intubation, perhaps because of the marked angle of the blade . Even with a good view of the larynx, passage of the tube into the trachea may be difficult ; the Glidescope does not require alignment of the three airway axes (oral, pharyngeal and tracheal), and the tracheal tube must be introduced around the curve of the Glidescope blade at the base of the tongue .…”

Section: Introductionmentioning

confidence: 99%

“…To overcome this, the tracheal tube is often pre‐shaped with a rigid stylet to an angle of 60° in order to match the curvature of the Glidescope blade. This marked angle can create problems, however, as the tracheal tube tends to be directed into the larynx at an almost perpendicular angle to the axis of the trachea . The anterior tracheal wall may add further resistance to tube passage .…”

Section: Introductionmentioning

confidence: 99%

“…The anterior tracheal wall may add further resistance to tube passage . Several manoeuvres have been described to address this issue, such as: the use of a gum elastic bougie or semi‐rigid catheter with a controllable tip; clockwise rotation of the tracheal tube; ‘reverse loading’ the tube onto the stylet; or use of the Endoflex ® tracheal tube as a stylet‐free alternative . A special tracheal tube, the Parker Flex‐Tip ® tube with a posterior‐facing bevel and a symmetrical tip (Parker Medical, Highlands Ranch, CO, USA), has been recommended by the manufacturer of the Glidescope .…”

Section: Introductionmentioning

confidence: 99%

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Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope^® videolaryngoscope: a randomised, controlled comparison of three tracheal tubes

Gao

Xue

et al. 2016

Anaesthesia

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Difficulty during placement of the tracheal tube is a known problem when intubating with the GlideScope â , which may lead to subglottic airway injury. This randomised, controlled clinical trial was designed to compare the resistance to passage of PVC (polyvinyl chloride), reinforced or BlockBuster tracheal tubes during intubation with the GlideScope. Secondary outcomes included the time taken to intubate and assessment of subglottic airway injury. One-hundred and seventy-seven patients were included in the data analysis. There was difficult tracheal tube passage (moderate or severe resistance) in 15 (21.4%) patients using the PVC tube compared with 4 (7.4%) and 1 (1.9%) using the reinforced and BlockBuster tubes, respectively (p = 0.003 for PVC vs. BlockBuster). The median (IQR [range]) time taken to intubate was 35 (27-45 [15-115]) s, 25 (20-27 [15-110]) s and 25 (22-30 [16-90]) s, respectively, (p < 0.001 for PVC vs. reinforced as well as PVC vs. BlockBuster). Subglottic airway injury, assessed using a fibreoptic bronchoscope after extubation, was higher with the PVC tube (p < 0.001) and the reinforced tube (p = 0.012) compared with the BlockBuster tube. We conclude that the BlockBuster tracheal tube is a better choice for orotracheal intubation with the GlideScope than PVC or reinforced tubes.

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Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

Godoroja

Copăescu

Agache

et al. 2019

J Clin Monit Comput

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Video laryngoscopy (VL) is a well-established technique used in anaesthetising obese patients who present with higher risks of airway-related difficulties and desaturations due to shorter safe apnoea periods. However, VL has certain limitations and may fail. We present the Infrared Red Intubation System (IRRIS), a new technique facilitating glottis identification in severely obese patients undergoing anaesthesia for bariatric surgery. This single-centre, prospective trial assessed the efficacy of the IRRIS for VL tracheal intubation in 20 severely obese adult patients undergoing elective bariatric surgery under general anaesthesia. We assessed the ability of the IRRIS to differentiate the transilluminated glottis from the oesophagus and laryngeal folds and evaluated the ease of intubation. The average weight in the investigated patient cohort was 145 ± 29 kg, the suprasternal tissue thickness was 12 ± 4 mm. The median IQR [range] larynx recognition time was 10 [2-50] s, which was similar to that of lean patients. The degree of obesity correlated with the duration to achieve optimal laryngoscopic view and complete the intubation procedure. We achieved successful VL insertion on the first attempt in 13 of 20 cases (65%), and on the second attempt in 7 cases (35%), emphasising the increased probability of successful intubation on the first attempt. Tracheal intubation with the IRRIS lasted 50 [IQR 20-100] s. The lowest SpO2 during intubation was 98 [IQR 83-100] %. Addition of IRRIS to VL insertion facilitated the intubation of difficult airways in severely obese patients. IRRIS improves the visualization of the intubation pathway by selectively highlighting the airway entrance and shortens the time to successfully conclude the intubation procedure.

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Measures to facilitate smooth insertion of an endotracheal tube into the trachea with GlideScope videolaryngoscopy

Cited by 6 publications

References 6 publications

Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope^® videolaryngoscope: a randomised, controlled comparison of three tracheal tubes

Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

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Measures to facilitate smooth insertion of an endotracheal tube into the trachea with GlideScope videolaryngoscopy

Cited by 6 publications

References 6 publications

Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Videolaryngoscopy Assisted Intubation — New Era for Airway Management

Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope® videolaryngoscope: a randomised, controlled comparison of three tracheal tubes

Impact of retrograde transillumination while securing the airway in obese patients undergoing bariatric surgery

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Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope^® videolaryngoscope: a randomised, controlled comparison of three tracheal tubes