Tracheal intubation with the glidesSope® videolaryngoscope, using a “J” shaped endotracheal tube

Purpose:The GlideScope® videolaryngoscope usually provides excellent glottic visualization, but directing an endotracheal tube (ETT) through the vocal cords can be challenging. The goal of the study was to compare the dedicated GlideScope®-specific rigid stylet to the standard malleable stylet, assessed by time to intubation (TTI).Methods: Eighty patients requiring orotracheal intubation for elective surgery were randomly allocated to either the GlideScope® rigid stylet (GRS) or a standard malleable stylet to facilitate intubation using the GlideScope®. Time to intubation was recorded by blinded assessors; operators were blinded until after laryngoscopy. The operator assessed the ease of intubation using a visual analogue scale (VAS). The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were documented. Results:The median TTI was 42.7 sec (inter-quartile range (IQR) 38.9-56.7) for the GRS group compared to 39.9 sec (IQR 34.1-48.2) for the control group (P = 0.07). The median VAS score for ease of intubation was 20 (IQR 12.0-33.0) for the GRS group compared to 18 (IQR 9.5-29.5) for the control group (P = 0.21). There was no significant difference in TTI or VAS between stylets. The overall incidence of a Cormack-Lehane grade I or II glottic view was 98%. Conclusions:In a group of experienced operators using the GlideScope®, the dedicated GRS and the standard malleable ETT stylet are equally effective in facilitating endotracheal intubation. le temps requis pour l'intubation (TTI). Méthode : Quatre-vingts patients nécessitant une intubation orotrachéale pour une chirurgie élective ont été randomisés à être intubés à l'aide soit du mandrin rigide GlideScope® (GRS), soit du mandrin flexible standard pour faciliter l'intubation avec le GlideScope®. Le temps requis pour l'intubation a été mesuré par des évaluateurs en aveugle ; les opérateurs étaient également en aveugle jusqu'à ce que la laryngoscopie soit terminée. L'opérateur a évalué la facilité d'intubation à l'aide d'une échelle visuelle analogique (EVA). Le nombre de tentatives d'intubation, le nombre d'échecs, le grade d'intubation et le recours à une manipulation laryngée externe ont été notés.Résultats : Le TTI médian était de 42,7 sec (intervalle interquartile (IQR) 38,7) pour le groupe GRS comparé à 39,9 sec (IQR 34,2) pour le groupe témoin (P = 0,07). Le score EVA médian pour la facilité d'intubation était de 20 (IQR 12,0)

Section: Discussionsupporting

confidence: 90%

Section: Conclusion : Dans Un Groupe D'opérateurs Expérimentés Se Sermentioning

confidence: 99%

The GlideScope®-specific rigid stylet and standard malleable stylet are equally effective for GlideScope® use

Turkstra

Harle

Armstrong

et al. 2007

“…11 A common criticism of the GVL has been the difficulty with which an ETT passes through the vocal cords despite excellent glottic visualization. [1][2][3]5,12 Based on the TTI and ease of intubation VAS found in this trial, it is likely that the 90° configuration passes the glottis more easily than does the 60° configuration. This study has confirmed the excellent glottic view that one regularly obtains with the GVL (Table II).…”

Section: Discussionmentioning

confidence: 87%

“…2,3 Because of the 60° distal anterior curvature of the GVL blade, ETTs must have stylets inserted so that the ETT's distal tip can be positioned anteriorly. 2 Various authors have recommended different angles of the ETT to optimally place it into the trachea, including matching the blade's 60° angle, 1,4 using a "J-shaped" ETT, 5 or configuring the ETT with a 90° bend. 2 Regardless of the angulation used, the natural camber of the ETT tends to direct the distal tip of the ETT even further anteriorly when the stylet is retracted -possibly impeding the ETT from advancing into the trachea.…”

mentioning

confidence: 99%

Effect of stylet angulation and endotracheal tube camber on time to intubation with the GlideScope®

Jones

Turkstra

Armstrong

et al. 2007

CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: The GlideScope® videolaryngoscope usually provides excellent glottic visualization, but directing an endotracheal tube (ETT) through the vocal cords is sometimes difficult. The goal of the study was to determine which of two ETT angles (60° vs 90°) and cambers (forward vs reverse) was better, as determined by time to intubation (TTI). Methods:Two hundred patients requiring orotracheal intubation for elective surgery were randomly allocated to one of four groups: A) 90° angle, forward camber; B) 90° angle, reverse camber; C) 60° angle, forward camber; D) 60° angle, reverse camber. Time to intubation was assessed by a blinded observer. Operators were blinded until the point of intubation. A visual analogue scale (VAS) assessed the ease of intubation. The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were recorded. Results: The angle of the ETT had an impact on TTI but camber did not. The 90° angle demonstrated a 13% faster TTI than the 60° angle (47.1 ± 21.2 sec vs 54.4 ± 28.2 sec, P = 0.042), and it resulted in easier intubation (VAS 16.4 ± 14.2 mm vs 27.3 ± 23.5 mm, P = 0.0001). The overall incidence of a grade 1 or 2 Cormack-Lehane glottic view was 99%. Conclusions: In a heterogeneous group of operators and patients intubated with the GlideScope®, a 90° ETT angle provided the best result and should be the initial configuration. The camber of the ETT does not affect the time to intubation. 'avec une angulation de 60° (47,1 ± 21,2 sec vs 54,4 ± 28,2 sec, P = 0,042), et l' intubation était plus facile (VAS 16,4 ± 14,2 mm vs 27,3 ± 23,5 mm, P = 0,0001

“…8 In order to place it optimally into the trachea, various authors have recommended different curvatures of the ETT/stylet, including matching the blade's 60°angle, 1A configuring the ETT with a 90°bend, 4,5 or using a J-shaped ETT. 9 The GlideScope Ò manufacturer has designed a reusable stylet specifically for use with the GVL. This GlideRite Ò Rigid Stylet (GRS) is substantially more rigid than a standard malleable stylet (SMS).…”

Section: Résumémentioning

confidence: 99%

A randomized comparison of the GlideRite® Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope®

Jones

Loh

Youssef

et al. 2010