Tips and Troubleshooting for Use of the GlideScope Video Laryngoscope for Emergency Endotracheal Intubation

Use of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial*

“…Despite improved glottic visualization, there was no difference between GlideScope (Verathon) and direct laryngoscopy in the time needed to correctly position the endotracheal tube when first-to third-year nonanesthesiology residents were in charge (9). This may, in part, be explained by the fact that visualization of the glottis as judged by the CormackLehane score is significantly better during video laryngoscopy versus direct laryngoscopy, but manipulation of the endotracheal tube can be challenging (10)(11)(12). Finally, in a review comprising 17 studies enrolling 1,998 patients, the advantage of video laryngoscopy was even more pronounced when the airway was defined as difficult or when operators were less qualified (13).…”

“…In our study, physicians had problems to direct and advance the tube, which was armed with a rigid stylus, toward the larynx or trachea in 27% (47/168). This phenomenon is well known and described as a typical GlideScope intubation problem, which may be overcome with improved handling, such as shifting the blade to the left, backing up, holding the tube more proximally, and retracting the stylet as soon as the vocal cords are passed (12). Accordingly, there is strong evidence that expertise in video laryngoscopy requires prolonged training and practice, and a minimum of 76 attempts are considered necessary to achieve proficiency (32,33).…”

A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation

“…This was presumably caused by differences between the direct and indirect view of the investigated laryngoscopes. Indirect view of video laryngoscope is advantageous to visualization of the glottic inlet, but the field around the glottic inlet on the video display is narrower compared to the direct view of Macintosh laryngoscope 17 , 18 . Our results indicate that the direct view provided by the Macintosh laryngoscope of the areas between the tracheal tube and the glottic inlet is important for the alignment of the tracheal tube tip into the glottic inlet via manipulation and movement of the tracheal tube with the right hand.…”

Videolaryngoscopy, the Current Role in Airway Management

“…To gain great maneuverability with the tube, it is advisable to hold the tube closer to its connector, not to be to too close with the view to the glottis (back it up), and in the case of difficulty, passing through the glottis to use the bougie [71]. In addition, some propose to view videolaryngoscopy as a four-step procedure: First step is to look in the mouth and insert the videolaryngoscopy blade under direct vision.…”